Empire State Medical, Scientific and Educational Foundation

Providing High Quality Medical Peer Review & DRG/Coding Validation

Coding and DRG Validation

The Foundation has over 30 years’ experience in providing coding and DRG validation services to providers and payors in all settings.  Medical records are reviewed by certified coders and Board Certified physicians currently in active practice.  Our certified coders are
extensively trained and have many years of coding experience. 

The Foundation served as the New York State Dispute Resolution Agent from 1991-1996 (when the legislation sunsetted) and performed review of acute care claims for appropriateness of coding and DRG assignment. 

The Foundation has continued to serve as a dispute resolution/external appeal agent for providers and payors who contractually agree to an independent external review. 

The Foundation serves as a subcontractor to the New York Medicaid Utilization Review and Quality Assurance agent, and has performed over 130,000 reviews for appropriateness of coding and DRG assignment.

The Foundation has stringent procedures to protect the confidentiality of all health information submitted to us for review.

The Foundation has strict policies in place to guard against any conflict or perceived conflict of interest when assigning staff/physician specialists to a review.

The Foundation is experienced in meeting stringent timeframes with respect to the coding and DRG validation process.

With our extensive experience in performing coding and DRG validation, the Foundation is in a strategic position to assist providers and payors with a coding/DRG validation review program.