Rising Dispute: Clinical Validation Audits

The rise of third-party payer audits is no secret to healthcare professionals and facilities, but one type of audit has gained particular attention in recent years: the clinical validation audit. Clinical validation audits ultimately lead to a downgrade of a hospital’s diagnostic-related group (DRG) payment, but the process by which they reach that result makes them particularly curious. During utilization review, health plans make decisions about the patient’s care and, in the case of clinical validation audits, actually make determinations about whether documented medical diagnoses are “clinically valid”. Join us to hear how clinical validation audits work and the rise in provider disputes involving clinical validation audits. Broadcast segments will also include these instantly recognizable panelists, who will report more news during their segments: · POV: Penny Jefferson, Director of Coding & Clinical Documentation Integrity Services for the University of Davis Medical Center, will share her point of view during the broadcast. · CDI Report: Cheryl Ericson will provide an update on clinical documentation integrity (CDI). · SDoH Report: Tiffany Ferguson, CEO for Phoenix Medical Management, reports on the news that’s occurring at the intersection of medical records and federal regulations. · The Coding Report : Christine Geiger will report on the latest coding news.

You can listen to Rising Dispute: Clinical Validation Audits online on Radio and Podcast. Open the player on this page to stream the available audio.

Rising Dispute: Clinical Validation Audits is an episode from Talk Ten Tuesdays by ICD10monitor.

This episode is 29:53 long.

This episode was published on Mar 10, 2026.

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