DRG-Downgrade Challenge
Paid-but-downgraded DRG claims that never appear on denial dashboards. Clinovian constructs the clinical-coding crossover argument with severity markers, timestamps, and coding-principle framing.
Paid-but-downgraded DRG claims never appear in denial dashboards because the claim was paid at a lower rate, not denied outright. Clinovian constructs the clinical-coding crossover argument — full chart reconstruction with severity markers, timestamp precision, and coding-principle framing — that complements your CDI team's work.
- 870/871 — Sepsis ($10K–$25K delta)
- 291/293 — Heart Failure ($4K–$8K)
- 003/004 — ECMO/Trach ($20K–$40K)
- 460/461 — Spinal Fusion ($6K–$12K)
- 329/331 — Major Bowel ($8K–$15K)
Chart reconstruction, severity-marker extraction with timestamps, payer-auditor point-by-point rebuttal, and coding-principle-aware argument framework. Designed to integrate with CDI workflows, not replace them.
Send a de-identified case. Free suitability screen.
No PHI, no commitment. Physician verdict in 24–48 hours: pursue, do not pursue, or needs more information.