ESMSEF has over 40 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 until 1996 (when the legislation sunset) and performed reviews of acute care claims for appropriateness of coding and DRG assignment. We 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. We have stringent procedures to protect the confidentiality of all health information submitted to us for review.
Our organization 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.