DRG Validation

Left unchecked, DRG coding errors quietly erode revenue. EnableComp delivers the industry’s most trusted post-bill DRG validation for maximum reimbursement.

How EnableComp conquers DRG Validation complexity

With shifting payer policies and rising coding complexity, even strong coding programs can miss revenue and trigger compliance risk. EnableComp applies deep DRG expertise and intelligent automation to:

Interpret clinical nuance to ensure every diagnosis and procedure code aligns with the patient’s true severity of illness and resource use.
Validate documentation accuracy so that coding fully supports reimbursement and withstands payer or regulatory audit.
Detect coding discrepancies that lead to downgrades, denials, or underpayments across high-value inpatient claims.
Apply payer-specific logic to account for contract terms, audit targets, and reimbursement variations across commercial and government payers.
Deliver corrective insight that strengthens future coding accuracy and reduces preventable compliance exposure.

EnableComp’s DRG Validation solution, part of our Complex Revenue Recovery Suite, drives measurable results on its own – and even greater impact when used with the full Suite.

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Why choose EnableComp for DRG Validation

Managing DRG validation requires more than coding accuracy – it demands clinical insight, contractual fluency, and the foresight to catch what others overlook.

EnableComp brings all three together, pairing our AI-powered e360 RCM® adaptive technology with expert auditors and coders who understand the full financial and compliance impact of every DRG shift.

We go beyond identifying errors to uncover opportunities, finding significant recoveries other vendors don’t find through their internal audits and legacy processes.

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Procedure code and DRG verification

EnableComp validates that every procedure code and DRG assignment accurately reflects the patient’s clinical picture and documented care. This ensures proper reimbursement and reduces the risk of payer disputes.

Proprietary advanced rules engine

We maintain the largest procedure-based rules engine – built and refined over nearly three decades – that targets high-probability cases with unmatched precision. This technology enables our DRG team to identify even subtle discrepancies that impact reimbursement or compliance.

Client approval on any changes prior to rebill

As your partner, we collaborate closely with your team, confirming every recommended adjustment before a claim is rebilled to ensure accuracy, transparency, and full client control.

Proven recovery performance that others can’t deliver

EnableComp consistently finds substantial savings and compliance improvements where others don’t. Our approach to DRG Validation is proven by top health systems nationwide.

Our DRG Validation solution drives maximum revenue recovery

Comprehensive post-bill review

We conduct a full post-bill review of inpatient claims to verify DRG accuracy, uncover missed revenue, and ensure every claim is properly coded, aligned, and reimbursed.

Contract reviews

We review contracts to capture the financial picture, evaluating DRG payments, transfer rules, and cost outliers to uncover underpayments and missed revenue.

Formal appeals process

We handle all DRG denial appeals resulting from our recommendations, ensuring accurate reimbursement and sustained compliance throughout the process.

Proactive DRG shift tracking

We track DRG shifts across all claims, including pending denials, to reveal revenue impact, uncover missed payments, and drive stronger financial performance.

Root cause analysis and education

We deliver actionable insights to prevent recurring errors, providing root cause analysis and education that improve documentation and protect future revenue.

CLIENT SUCCESS STORY

Uncovering $60M Beyond the Review: How Post-Bill DRG Validation Delivered What Others Missed

A leading health system with $11B NPR and 182,000 annual discharges turned to EnableComp’s post-bill DRG Validation solution to strengthen revenue integrity.

Even after reviews by another CDI and a pre-bill vendor, EnableComp uncovered $60M in additional annual recoveries, proving the unmatched precision and value of our DRG Validation services.

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$60M

annual recovery

behind another CDI + pre-bill DRG-V vendor

Our clients say it best

“The firm [EnableComp] is very professional, prompt, and proactive. When they identify a trend or an issue, they bring it to our attention immediately. Their reporting is very good and detailed. They are just outstanding all around. I can reach out to them and ask for a report, and they will promptly return that report.”

- RCM Analyst, KLAS Interview, July 2025

Transform results with the complete Revenue Recovery Suite

Each solution in our Revenue Recovery Suite delivers results on its own, but when hospitals partner with EnableComp for all three – DRG Validation, Zero Balance Review, and AR Resolution – the impact multiplies.

Our integrated expertise and proprietary technology align every aspect of revenue recovery, unlocking financial outcomes once considered out of reach.

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Connect with us to unlock hidden revenue

Learn how our e360 RCM® platform, decades of data-driven insight and specialized expertise help hospitals recover more revenue, faster.