Who performs coding review and DRG validations?
Coding review and DRG validation are performed by HSI utilization review coordinators who are registered nurses. These URCs are trained in the principles of ICD-9-CM coding and DRG validation and achieve a level of reliability. Final coding verification on all DRG referral cases is performed by a Registered Health Information Administrator or Certified Coding Specialist. b) Is there a focus list of particular DRGs that are being reviewed? Attachment D contains the list of DRGs that are subject to retrospective prepayment review. Please visit HFS’ Web site at http://www.hfs.illinois.gov/proqio to download Attachment D. back to top 5) Confidentiality and Patient Privacy a) Is HSI considered to be a HIPAA business associate? Yes. HSI maintains a Business Associate Agreement with the Illinois Department of Healthcare and Family Services. b) Do hospitals need to obtain consent to release information prior to calling in clinical information for concurrent review? No. Since HFS is reimbursing
