Certified Inpatient Coding (CIC) Practice Exam

Which role is responsible for reviewing the appropriateness of DRG assignment of inpatient claims?

1. Coding Auditor

2. DRG Validator

3. Coding Compliance Officer

4. Documentation Improvement Specialist

The correct answer is: DRG Validator

The role responsible for reviewing the appropriateness of Diagnosis-Related Group (DRG) assignments for inpatient claims is the DRG Validator. This position plays a crucial role in ensuring that the DRG assignments accurately reflect the medical necessity and complexity of the care provided to patients during their hospital stays. The DRG Validator examines both the clinical documentation and coded data to confirm that the DRG assigned aligns with the services rendered, thereby preventing discrepancies that could lead to revenue loss or compliance issues for healthcare providers. By focusing on the accuracy of DRG assignments, the DRG Validator helps maintain the integrity of data that are essential for hospital reimbursement and operational reporting. Their expertise enables them to identify potential errors, suggest corrections, and ensure that the coding aligns with regulatory requirements and guidelines, thus supporting proper reimbursement and minimizing auditing risks. In contrast, other roles may have different responsibilities in the coding process. While a Coding Auditor typically reviews coding practices for compliance and accuracy, and a Coding Compliance Officer oversees adherence to coding policies and regulations, a Documentation Improvement Specialist focuses on enhancing the quality of clinical documentation rather than specifically validating DRG assignments.