Challenged to keep up with dynamic regulatory change relating to prospective payment systems? Aren’t certain what the impact is to you? Concerned about denials for services and claims from you fiscal intermediary (FI)? Want to make certain your coders are able to code based on the new MS-DRGs? Do they understand how to code for quality, compliance, and payment? Want to know how to code and bill for different classification systems but for the same patients?

3M grouping solutions are designed for use by hospital professionals who can make a difference in the hospital’s ability to comply with federal and state payment regulations and with third-party payer payment policies for billing of services provided to their beneficiaries. They are developed for use by HIM and billing office professional providing guidance and alerts to help assure complete, consistent, and compliant coding and billing to facilitate submission of clean claims the first time. This embedded logic helps to minimize payment delays, to reduce costs, and to improve revenues. There are groupers for inpatient and outpatient prospective payment systems used by Medicare, Medicaid, and third-party payers. They offer the following functions:

1. Validation of codes
2. Review of codes for proper use based on gender and age
3. Calculation of payment based on specific payer rules and regulations
4. Support of interfaces for linkage with other hospital systems, such as billing
5. Provision a full set of CMS defined edits including both MCE and OCE
6. Inclusion of additional 3M proprietary edits to improve coding completeness and regulatory compliance and to improve claim accuracy for clinical components
7. Inclusion of regular updates to help users stay current with regulations
8. Provision of functionality that allow each facility to maintain their unique values
9. Support of add-on functionality for medical necessity
10. Integration into the 3M data storage and reporting system
11. Support of analyzer functionality to review Medicare’s MS-DRGs and 3M’s APR-DRGs for proper coding
12. Calculation of relative weights supporting casemix analysis

• 3M™ Core Grouping Software for Microsoft® Windows-based systems — Provides accurate and efficient grouping, editing, and calculation of expected reimbursement for inpatient and outpatient claims for providers, payers, fiscal intermediaries, as well as state and federal agencies.
• 3M™ Clinical Claims Editor Software for z/OS™ Mainframes — Provides accurate and efficient grouping, editing, and calculation of expected reimbursement for inpatient claims for providers, payers, fiscal intermediaries, as well as state and federal agencies.
• 3M™ APC Grouper Plus Software for z/OS™ Mainframes — Provides accurate and efficient grouping and editing of outpatient claims data under the Medicare and TRICARE outpatient prospective payment systems (OPPS).