And we can show you how to use them to improve the quality of care, lower costs, and enhance population health. Hear Jedi ALM, Vice President of Health Network Services, discuss how 3M’s APR DRG methodology turned out to be better than Madras for paying commercial claims.
Over 2,400 hospitals have licensed 3M APR Dogs to verify payment and analyze their internal operations. The 3M APR DRG methodology classifies hospital inpatients according to their reason for admission, the severity of illness, and the risk of mortality.
Payers often use 3M APR Dogs as the basis for an inpatient prospective payment method and as the risk adjuster in measuring hospital quality. Here are a few examples of how the 3M APR DRG patient classification methodology can bring value to health care organizations.
3M APR Dogs have been used in multiple analyses as the risk adjuster to make fair comparisons across hospitals on quality measures such as mortality, potentially preventable complications, and potentially preventable readmissions. Hospitals, state agencies, payers, and researchers use 3M APR Dogs to yield insights about clinical care.
For example, analysis in multiple states has quantified the sharp inverse relationship between birth weight and the hospital’s cost of neonatal care. The occurrence of an inpatient stay is used in the 3M ™ Patient-focused Episodes (PFE) Software to define an episode of care that includes the inpatient stay, the associated hospital and professional services, and related post-discharge services (such as rehabilitation).
Each payer that uses 3M APR Dogs makes its own decisions about prices and payment policies. For hospitals, other providers, health plans and other organizations that seek to understand, predict and verify expected payment, 3M makes available software that emulates payer-specific grouping, pricing and payment policy.
3M's experts are available to advise provider organizations, health plans, government agencies and other interested parties on how to obtain maximum value from using the 3M APR Dogs. 3M's consultants can also help payers design payment methods based on 3M APR Dogs and demonstrate how to use 3M APR Dogs to understand patterns of utilization, charges, cost and payment.
All the data required to assign an APR DRG can be obtained from a standard inpatient hospital discharge record, such as the UB-04 form or the X12N 837I electronic transaction. The 3M APR DRG logic uses claims data to assign patients to one of 326 base 3M APR Dogs that are determined either by the principal diagnosis, or, for surgical patients, the most important surgical procedure performed in an operating room.
Each base 3M APR DRG is then divided into four severity of illness (SOI) levels, determined primarily by secondary diagnoses that reflect both comorbid conditions and the severity of the underlying illness, creating the final set of 1,306 3M APR Dogs. The present-on-admission (POA) indicator for each secondary diagnosis is a required data field for computing the severity of illness at the time of admission.
The clinical logic is maintained by a team of 3M clinicians, data analysts, oncologists, programmers and economists. Please note that payers and other users of the 3M APR DRG methodology are responsible for ensuring that they use relative weights that are appropriate for their particular populations.
3M releases a new version of the 3M APR Dogs every October 1 to reflect updates in the ICD-10 diagnosis and procedure code sets and to include enhancements to the clinical classification logic. These documents are listed here for the information of readers interested in the various ways that 3M patient classification methodologies have been applied.
Also note that listing these references does not imply endorsement of 3M methodologies by individual authors, other organizations or government agencies. Through Dogs, a hospital is able to gain a detailed understanding of the number and type of patients they treat (case mix).
Hospitals and government departments then analyze this data to determine performance, quality, pricing and reimbursement, and to inform decision-making, health service planning, utilization management and epidemiology. Users who wish to install the AHQ Quality Indicators' software without the grouper may do so by choosing “I do not accept” below.
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As used herein, the term software shall mean a limited-functionality version of 3M ’s proprietary APR Software, including its content (the logic, formulas, algorithms and software code for selecting a particular code for defining or assigning a particular patient classification or subset of patient classifications or selecting a particular code or subset of codes contained or reflected in such Software), together with any enhancement or modification thereto (“Update”), which 3M delivers to the U.S. Department of Health and Human Services, Public Health Service Agency for Healthcare Research and Quality (“AHQ”) for incorporation into AHQ’s Quality Indicator Software. Title to the Software, and the ownership of all copyright, trademark, patent, trade secret, or any other right of a similar kind or nature arising under the laws of any country in the world (collectively, “Intellectual Property Rights”) thereto, are the property of 3M and/or its suppliers.
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CONTACT SALES Providing consistent DRG assignment regardless of the coding system The 3M IR- DRG methodology is versatile and code-independent, meaning that 3M Irides provide the same results in classifying patients regardless of the type of coding systems used.
The 3M IR- DRG patient classification methodology discriminates between inpatient and ambulatory encounters, while consistently grouping cases with similar resource consumption. Each 3M IR- DRG code describes patients who are similar both clinically and in their resource consumption.
The 3M Irides are currently used in various health care systems around the world, including Hong-Kong, Chile, the United Arab Emirates, the Czech Republic and Spain. At this time, 3M does not offer software that replicates the 3M IR- DRG analysis used in specific countries.
Countries such as Spain and Belgium also use the 3M APR Dogs for reporting and payment adjustment. 3M's experts are available to advise government agencies, hospitals, third parties and other interested entities on how to obtain maximum value from the use of the 3M Irides.
3M Irides use procedures rather than principal diagnosis as a starting point to better align with ambulatory components and reduce redundancy. All the data required to assign a 3M IR- DRG code can be obtained from standard patient records.
Crucial data fields for 3M IR- DRG assignment include all procedure and diagnosis codes, present-on-admission indicators (POA's), procedure code dates, length of stay and basic patient demographics. The development objective of the second version of the 3M Irides is to create a single 3M IR- DRG classification system that can group all types of patients.
This trend created the need for a single 3M IR- DRG system that spans the complete continuum of care settings. 3M Irides are continuously maintained to reflect current knowledge and classifications used worldwide, accommodating country-specific modifications and procedure coding systems.
Please note that payers and other users of the 3M IR- DRG methodology are responsible for using relative weights appropriate for their populations. The 3M IR- DRG logic is proprietary to 3M and maintained by a team of 3M clinicians, data analysts, oncologists, programmers and economists.
The methodology is updated annually to reflect changes in the standard diagnosis and procedure code sets as well as 3M enhancements to the clinical logic. When 3M business partners subscribe to 3M Grouper Plus Content Services (GPS), 3M experts do the heavy lifting to maintain and update complex and dynamic regulatory information.
You can also reduce IT expenditures, because there’s no local software installation or the need to modify interfaces when new content is received. This very popular solution is used by providers, payers, fiscal intermediaries, and state and federal agencies.
It can operate in batch mode (to process high volumes of claims data) or in “interactive mode” (to let you enter, modify, and process individual claims and review the output from the grouping and reimbursement calculation). Solutions are also available for hospitals (inpatient and outpatient services), physicians, and renal dialysis centers.
Do you or your clients need help with contracting, disease management, provider profiling, or quality and outcomes measurement? The 3M Clinical Risk Grouping Software is a grouper that measures an individual’s chronic illness burden using inpatient, ambulatory, and pharmacy data over a period of time and provides the basis for predicting future use of medical services.
This 3M -proprietary methodology addresses all population groups to better reflect current clinical care complexities, practices, and cost structures for outpatient services. It is being adopted by many states and payers to simplify and streamline the outpatient prospective payment process.
Today, 3M supports grouping, editing, and reimbursement configurations for over 50 federal, state, and commercial payer and reporting organizations implemented for payment, quality and public reporting and also provides access to reimbursement calculations for federal, state, and commercial payers. The 3M Inpatient and Outpatient Payment Calculation Toolkits allow payer and provider clients to calculate expected reimbursement for hospital inpatient and outpatient payment methodologies that are not supported within the 3M Core Grouping Software, the 3M Grouper Plus System, or equivalent mainframe solutions.
Though this reimbursement scheme does not use grouping, you should set up your schedule to use the One/APC grouper to ensure you receive the appropriate edits. This software solution addresses the complexities of Medicare's newly implemented prospective payment system for these services.
Are you looking for an accurate, specific coding system updated with current regulations and comprehensive edits? The system is available as a Microsoft® Windows® application or a web-based edition and also offers a wide selection of groupers and reimbursement formulas to support many federal and state payment and quality initiatives.
Section 1886(d) of the Act specifies that the Secretary shall establish a classification system (referred to as Dogs) for inpatient discharges and adjust payments under the IPS based on appropriate weighting factors assigned to each DRG. Therefore, under the IPS, we pay for inpatient hospital services on a rate per discharge basis that varies according to the DRG to which a beneficiary's stay is assigned.
Congress recognized that it would be necessary to recalculate the DRG relative weights periodically to account for changes in resource consumption. Accordingly, section 1886(d)(4)(C) of the Act requires that the Secretary adjust the DRG classifications and relative weights at least annually.
Currently, cases are classified into Medicare Severity Diagnosis Related Groups (Madras) for payment under the IPS based on the following information reported by the hospital: the principal diagnosis, up to 24 additional diagnoses, and up to 25 procedures performed during the stay. In a few Madras, classification is also based on the age, sex, and discharge status of the patient.
Effective October 1, 2015, the diagnosis and procedure information is reported by the hospital using codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS). For additional information on the MS- DRG system, including yearly reviews and changes to the Madras, please view prior Inpatient Prospective Payment System (IPS) proposed and final rules located in the left navigational area of this page.
CMS is hosting a listening session that will describe the Medicare-Severity Diagnosis-Related Group (MSC DRG) Complication and Comorbidity (CC)/Major Complication and Comorbidity (MCC) Comprehensive Analysis discussed in the FY 2020 Inpatient Prospective Payment System (IPS) proposed and final rules. This listening session will include review of the methodology to measure the impact on resource use and will provide an opportunity for CMS to receive public input on this analysis and to address any clarifying questions in order to assist the public in formulating written comments on the current severity level designations for consideration for FY 2021 rule making.
Under the Hopes version of the Madras developed for this requirement, to the extent feasible, the MS- DRG assignment for a given service furnished to an outpatient (billed using a Hopes code) is as similar as possible to the MS- DRG assignment for that service if furnished to an inpatient (billed using an ICD-10-PCS code). The HCPCS-MS- DRG definitions manual and software developed under the requirements of section 15001 of the 21st Century Cures Act (Public Law 114–255).
3M has more than 30 years of experience developing classification, grouping and reimbursement calculation systems for inpatient, outpatient and professional settings. Methodologies for defining and measuring risk adjustment, payment, reporting and quality improvement.
Major payers in more than 30 states use 3M patient classification methodologies to pay providers and measure health care quality. 3M offers grouping and pricing software that you can use to predict and verify payment, understand quality measurement algorithms, and analyze your own data to improve performance.
Check out what our clients and 3M experts have to say about our patient classification methodologies solutions. 3M CGS create a bridge between the clinical and financial aspects of health care.
When you have deep insights into clinical complexity, you can distinguish between patients who share the same diagnosis but differ widely in their severity of illness, overall health status and their projected use of healthcare resources. Readmissions are a vitally important outcome measure to track for population health.
Admiral Davy explains how the 3M ™ Potentially Preventable Readmissions (PPR) Grouping Software is also vitally important in helping Alaina Heath manage patients’ health, guide care transitions and reduce readmissions. 3M's services and solutions can help payers and providers go beyond patient classification.
Regardless of setting, 3M can help organizations gain more visibility into analytics, quickly identify root causes and recommend improvements for long-term success. From the minute you invest in the 3M performance improvement solution, an experienced 3M team is assigned and dedicated to your success.