According to Medicare regulations: - “Clinical validation involves a clinical review of the case to see whether or not the patient truly possesses the conditions that were documented in the medical record.” - “The purpose of DRG [clinical] validation is to ensure that diagnostic and procedural information…coded and reported by the hospital on its claims matches the attending physician’s description and the information contained in the medical record.” The consequences of submitting clinically invalid diagnoses are numerous and can be severe: improper DRG reimbursement, excessive denials, unnecessary appeals, risk of regulatory audits and penalties