NewBecker's 2026 Top RCM · Inc. 5000 · Dallas 100
One ASC cut aged A/R from $4.55M to $0.76M in nine months →
SOC 2 Type 2 · HIPAA · BHCOE · CASP
Most DRG validation programs focus only on increasing reimbursement by identifying CC/MCC opportunities. Plutus Health takes a dual-lens approach. Using PE Sampling AI, PE Full Review AI, and AHIMA-certified inpatient coding specialists, we identify defensible revenue opportunities while simultaneously reducing RAC exposure, documentation risk, and coding vulnerabilities.
Get Your Free RCM Assessment →Explore All 25 AI Agents →We review inpatient documentation before claims are finalized to validate MS-DRGs, APR-DRGs, IR-DRGs, CC/MCC capture, and principal diagnosis selection while reducing future coding corrections.
Our post-discharge reviews identify missed reimbursement opportunities, coding inaccuracies, documentation gaps, and RAC exposure before external auditors discover them.
We improve Case Mix Index through defensible clinical documentation, accurate severity capture, and complete coding, not artificial reimbursement inflation.
Our specialists identify gaps in physician documentation, missing clinical indicators, and opportunities to improve coding accuracy and audit defensibility.
Every validation includes reviews for compliance with CMS regulations, ICD-10-CM, ICD-10-PCS, Official Coding Guidelines, SOI, ROM, and payer-specific inpatient requirements.
We translate findings into physician education, CDI recommendations, coder feedback, and documentation improvement initiatives that strengthen long-term performance.
PE Sampling AI evaluates every inpatient encounter and prioritizes charts with the greatest opportunity for reimbursement improvement, documentation enhancement, or compliance risk.
PE Full Review AI validates diagnoses, procedures, physician documentation, DRG assignment, severity levels, and coding compliance before escalating complex clinical judgment to certified inpatient coding specialists.
OlympusAI continuously measures DRG shifts, Case Mix Index trends, reimbursement impact, coding accuracy, physician documentation quality, and audit readiness across the organization.
Rather than reviewing charts randomly, OlympusAI identifies inpatient encounters with the highest financial value, documentation complexity, reimbursement opportunity, and audit exposure.
Each chart is reviewed through two perspectives simultaneously: maximizing defensible reimbursement while identifying coding decisions that could create RAC, payer, or compliance risk.
AHIMA-certified inpatient coding specialists validate AI findings, recommend documentation improvements, prepare rebilling opportunities where appropriate, and provide long-term CDI guidance.
Our 30-day DRG validation assessment reviews inpatient coding, clinical documentation, Case Mix Index opportunities, reimbursement accuracy, and RAC vulnerability to deliver a defensible roadmap for revenue improvement.
