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What is DRG Claims Management?

It is indeed true that "not all DRG vendors are created equal." While their promotional tactics might appear alike, these vendors typically fall into two distinct groups: those that primarily serve provider hospitals and those that concentrate on identifying overpayments for health plans and payers. Similar to how lawyers often specialize in either defending or prosecuting cases, auditing vendors usually focus on the unique requirements, cultures, and interests of their particular client base. Among the vendors that prioritize payers, there exists a wide variety of strategies for DRG auditing and overpayment detection. Additionally, our service portfolio features a dedicated team of physicians who conduct clinical reviews to produce validation findings, specifically targeting situations where recognized problems arise from unsupported clinical diagnoses made by attending physicians, which surpasses the capabilities of coders. Our results consistently indicate that our coding compliance model leads to verified savings, thus enhancing financial efficiency for healthcare providers. Therefore, the choice of the right vendor can have a profound effect on the financial stability of both hospitals and payers alike, highlighting the importance of careful vendor selection in the healthcare landscape. Furthermore, this distinction among vendors underscores the necessity for stakeholders to understand their specific needs when seeking partnerships for effective revenue management.

What is ClearRoster?

ClearRoster is a web-based application tailored for small healthcare practices to facilitate exclusion screenings and record management. Users have the option to either enter the names of staff and vendors individually or upload a spreadsheet, while ClearRoster conducts monthly verifications against the federal OIG List of Excluded Individuals/Entities, SAM.gov exclusions, and 15 state Medicaid exclusion or termination lists. The system not only provides close name matches but also details the matching methodology and guides users to the publisher’s search for additional verification of any potential matches. In addition, ClearRoster keeps a comprehensive and dated log of the monthly screenings, which includes the specific sources that were checked, their last updated dates, the names that were screened, and the results of these evaluations, all of which can be downloaded for future reference. Users should be aware that having similar names does not necessarily indicate exclusion, thus they are required to carefully assess any potential matches. The service is limited to the designated states and is specifically designed as a screening and recordkeeping tool, without providing any legal or compliance advice. Furthermore, ClearRoster strives to ease the process for healthcare practices, ensuring they remain aware of any exclusions that may affect their operations, which ultimately supports their commitment to providing quality care. By utilizing this tool, healthcare professionals can better manage their compliance risks while focusing on patient service.

Media

Media

No images available

Integrations Supported

Additional information not provided

Integrations Supported

Additional information not provided

API Availability

API Availability

Pricing Information

Pricing not provided

Pricing Information

$29/month, 14-day free trial
14-day free trial; $29/month for up to 100 people and vendors, or $49/month for up to 500. No card needed to start.
Free Trial Offered?

Supported Platforms

SaaS

Supported Platforms

SaaS

Customer Service / Support

Standard Support
Web-Based Support

Customer Service / Support

Not specified

Training Options

Documentation Hub
On-Site Training

Training Options

Not specified

Company Facts

Organization Name

DRG Claims Management

Date Founded

2009

Company Location

United States

Company Website

www.drgclaims.com/solutions/

Company Facts

Organization Name

Neverclosed

Company Website

clearroster.tryneverclosed.com/

Categories and Features

Healthcare Compliance

Not specified

Categories and Features

Healthcare Compliance

Not specified

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