Developing an Effective Compliance Audit Process Appendix D: Sample Indicators for DRG Evaluation


DRG pair 079/089

Numerator = all (Medicare) claims with DRG 079 Denominator = the sum of all (Medicare) claims with DRG 079 plus all claims with DRG 089

DRG pair 087/127

Numerator = all (Medicare) claims with DRG 087 Denominator = the sum of all (Medicare) claims....