Transfer Diagnosis Related Group (DRG) Reconciliation and Follow-Up Sample Clauses

Transfer Diagnosis Related Group (DRG) Reconciliation and Follow-Up. Based on current Medicare reimbursement policies and requirements, identify, investigate and appeal claims (specific DRGs) that were paid at a lower level based on subsequent services (e.g., skilled nursing facility, home health, etc.) that did not subsequently occur. Once DRG is identified as appealable, construct appropriate case for DRG validation based on full review of medical record and official coding guidelines, and write appeal letters to the relevant party based on Medicare and applicable payer appeal guidelines. The Operating Oversight Council shall approve all forms of any appeal letters and, as clarified in Exhibit 18.8, in the event that legal counsel representing IMH needs to be engaged in connection with any appeal, the selection of such counsel shall be made by IMH in its sole discretion and at IMH’s sole expense.