Alpine Pro Health delivers certified, AI-assisted Inpatient Diagnosis Related Group (IP-DRG) coding — ensuring accurate assignment, full compliance, and optimized reimbursement for hospitals and health systems across the U.S.
Inpatient Diagnosis-Related Group (IP-DRG) coding is the classification system used by Medicare, Medicaid, and most payers to determine reimbursement for hospital inpatient stays. Each episode of care is assigned a DRG code based on the principal diagnosis, secondary diagnoses, procedures performed, complications, comorbidities (CC/MCC), patient age, and discharge disposition.
Inaccurate DRG assignment — even by a single missed CC or MCC — can result in significant revenue loss, claim denials, or compliance exposure. Alpine Pro Health's certified coders specialize in maximizing appropriate DRG capture so your facility receives every dollar it has earned.
From chart abstraction to DRG validation, our certified coders cover every aspect of inpatient revenue integrity.
Accurate principal diagnosis selection, ICD-10-PCS procedure coding, and CC/MCC capture to ensure proper Medicare Severity DRG assignment and reimbursement.
Concurrent and retrospective review of inpatient records to identify documentation gaps that could downgrade DRG assignment or trigger audits.
All Patient Refined DRG coding for Medicaid and commercial payers, capturing Severity of Illness (SOI) and Risk of Mortality (ROM) levels accurately.
Collaborative CDI programs that bridge the gap between clinical documentation and coding, improving specificity, completeness, and DRG accuracy.
Independent DRG validation audits to catch under-coding, over-coding, and coding errors before claims are submitted — protecting revenue and reducing audit risk.
Comprehensive retrospective review of previously coded inpatient accounts to identify missed revenue opportunities and submit corrected claims compliantly.
Present on Admission (POA) indicator assignment and Hospital-Acquired Condition (HAC) screening to protect reimbursement and maintain regulatory compliance.
Expert-led clinical coding appeals for DRG-related claim denials, with detailed coding justification letters and peer-to-peer support.
GenAI and LLM-powered coding workflows that accelerate chart review, flag documentation gaps, and recommend DRG assignments — reviewed and validated by certified coders.
We combine certified expertise, advanced technology, and deep inpatient coding knowledge to deliver results that move the needle on your bottom line.
A streamlined, technology-enabled workflow from chart intake to clean claim submission.
Secure EHR access or chart upload. AI pre-reads for key diagnoses, procedures, and documentation cues.
Certified coders assign principal & secondary diagnoses, inpatient procedures, POA indicators.
DRG grouper run. CC/MCC checked. SOI/ROM levels validated. Discrepancies flagged for CDI query.
Second-level QA review. Compliance checks against CMS IPPS, PEPPER, and payer-specific guidelines.
Coded data delivered to your billing system. Monthly DRG mix reports and performance dashboards.
Our coders are trained across high-complexity inpatient MDCs and surgical DRG families.
MDC 5 — High-complexity, high-reimbursement DRGs
MDC 1 — Stroke, craniotomy, spinal procedures
MDC 8 — High-volume surgical DRGs
MDC 4 — Respiratory, ventilator, and ICU DRGs
Alpine Pro Health's IP-DRG services are built on a foundation of regulatory compliance, consistent with all CMS, OIG, and payer-specific guidelines.
Full alignment with CMS Inpatient Prospective Payment System rules, annual ICD-10 updates, and Official Coding Guidelines.
Coding decisions are documented and defensible, with a focus on DRG pairs and codes historically targeted by RAC, MAC, and OIG auditors.
Strict adherence to Uniform Hospital Discharge Data Set (UHDDS) guidelines for principal diagnosis selection and procedure sequencing.
All PHI is handled under HIPAA-compliant protocols with encrypted transfers, strict access controls, and signed BAAs.
We use CMS Program for Evaluating Payment Patterns Electronic Report data to benchmark your DRG mix and identify outlier risk areas.
Coding aligned to Medicare, Medicaid, commercial, and managed care payer policies — including Anthem, UHC, Aetna, and Blue Cross plans.
MS-DRG (Medicare Severity DRG) is the system used by Medicare for inpatient reimbursement under IPPS, classifying patients into one of ~760 groups based on diagnoses, procedures, and CC/MCC status. APR-DRG (All Patient Refined DRG) is used primarily by Medicaid and commercial payers, adding Severity of Illness (SOI) and Risk of Mortality (ROM) sub-classifications (1–4) to each DRG. Alpine Pro Health codes both systems accurately.
CC/MCC status directly determines which DRG tier a case is assigned to. For example, a pneumonia case without a CC may pay ~$5,400 under DRG 193, while the same case with an MCC moves to DRG 177 and pays ~$10,200. Systematically missing CCs and MCCs across hundreds of discharges per month creates significant, preventable revenue leakage. Our coders and CDI specialists are trained specifically to identify and capture all clinically supported CCs and MCCs.
Yes. We support integration with over 200 EHR and practice management platforms including Epic, Cerner, Meditech, Allscripts, and Athenahealth. Our team can access your system remotely through secure VPN, or work with chart exports delivered via encrypted SFTP. Coded data is returned in your preferred format (837I, 275 attachment, or direct system entry).
Standard inpatient accounts are coded within 24–48 hours. Complex surgical and critical care accounts may require 48–72 hours. For discharge not final billed (DNFB) backlog projects, we provide a detailed project timeline upfront with milestone reporting. We also offer concurrent inpatient coding programs that align with your facility's daily discharge workflow.
Our denials management team reviews all DRG-related denials, prepares detailed clinical coding rationale letters, and supports peer-to-peer reviews when required. We track denial patterns by payer and DRG family to identify systemic issues and prevent recurrence. Our appeal success rate for coding-related denials exceeds 80%.
All Alpine Pro Health inpatient coders hold AHIMA or AAPC credentials relevant to inpatient and facility coding — including CCS (Certified Coding Specialist), CIC (Certified Inpatient Coder), and RHIA/RHIT designations. Our coders maintain continuing education and stay current with annual ICD-10 updates, CMS IPPS final rules, and Official Coding Guideline changes.
Partner with Alpine Pro Health's certified IP-DRG coders and start capturing every dollar your facility has earned — compliantly and accurately.
Established in 2022, Alpine Pro Health. delivers accurate, compliant, and efficient medical coding and RCM solutions. Trusted by U.S. healthcare providers for expert-driven, end-to-end services.
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