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Who We Help

Payers

  • As a payer, how is your organization dealing with claim adjudication?
  • Is your staff spending more time on claim reconciliation or claim payment?
  • Are you more concerned with inpatient claim reimbursement or outpatient claim reimbursement?

For over 25 years, 3M Health Information Systems has offered innovative solutions to help payers effectively manage their provider relationships as well as accurately track and monitor member populations and their encounters with the healthcare system. 3M solutions have delivered information on resources used, quality reporting and outcomes, and claims management, and also helped build the foundation for partnerships with providers in a win-win environment.

Today, pay for performance, value based purchasing and transparency are on everyone's mind. 3M tools and services help payers focus on payment and reporting using readily available claims data. The resulting information can help payers manage quality and costs in a pay-for-performance (P4P) environment. Once implemented, 3M solutions track and report on services provided and give payers the information they need to collaborate successfully with providers in structuring an equitable P4P system.

Payers who implement 3M products also have access to the experts from 3M Consulting Services, who are available to help model solutions and compare results with current methodologies. 3M Consulting Services can also help payers conduct DRG reconciliation, group data and analyze the case mix or financial impact of a prospective payment system.

How 3M Helps

  • Provide tools for effective risk measurement and adjustment
  • Design clinically precise tools for disease management, provider profiling, and outcomes measurement
  • Using your payment methodology to achieve better alignment between payment incentives and clinical outcomes
  • Monitor inpatient and outpatient claims

What 3M Offers

  • Proprietary Inpatient Solutions

    • 3M™ All Patient Refined Diagnosis Related Groups (APR DRGs) Software is an inpatient classification tool that creates a severity-of-illness (SOI) score and a risk-of-mortality (ROM) score for all population groups. This tool provides a uniform process for qualifying the clinical differences in inpatient populations. Over the past 10 years, 3M APR DRGs have become the most widely used, non-Medicare severity adjusted tool in the United States. They have been used as the basis for payment systems as well as quality reporting processes. 3M APR DRGs should be considered the first step in creating successful pay for performance programs.
      To read more about 3M APR DRGs, click here.
    • 3M™ Potentially Preventable Readmission (PPR) Grouping Software is a batch grouping application that identifies readmissions which are potentially preventable by means of the powerful 3M PPR clinical methodology. The 3M PPR clinical logic determines whether a readmission is clinically related to an oversight from a previous admission. When used with APR DRGs, PPRs create a more robust analysis of readmissions. PPRs may be used for payment incentives or quality reporting.
    • All Patient Diagnosis Related Groups (AP DRG) Software is an inpatient classification system first developed by 3M Health Information Systems for use in the state of New York, but now adopted by numerous other states. AP DRGs focus on all populations (Medicare and non-Medicare alike) and may be used for reimbursement or quality reporting.
    • 3M™ Clinical Claims Editor (3M CCE) is an application that allows payers to evaluate claims submitted by providers for accuracy and completeness to generate the appropriate DRG assignment. 3M CCE operates on an IBM® mainframe platform in both batch and CICS environments. In the CICS environment, the application also calculates the appropriate reimbursement based on the grouper and reimbursement scheme being used.
      To read more about how 3M CCE can help you, click here.

  • Proprietary Outpatient Solutions

    • 3M™ Enhanced Ambulatory Patient Grouping (EAPG) System is an outpatient grouping tool that outlines the parameters for an outpatient prospective payment system by identifying the key procedures for ambulatory visits. The 3M EAPG System may be used for reimbursement or quality reporting.
      To read more about the 3M EAPG System, click here.
    • 3M ™APC Grouper Plus Software for the z/OS Mainframe (with the APC grouper and Outpatient Code Editor) is designed to group claims and calculate prospective reimbursement according to the Centers for Medicare and Medicaid Services (CMS) requirements for the outpatient prospective payment system (OPPS). The 3M software provides the necessary edits to help improve coding accuracy, completeness, and consistency.
      To read more about APCs, click here.

  • Proprietary Solution for Both Inpatients and Outpatients

    • 3M™ Clinical Risk Grouping Software (3M CRGs) an episodic grouper, is a risk adjustment management tool used to track all episodes of care and project future use of medical services. 3M CRGs may be used for contracting, disease management, provider profiling, and measuring or improving quality of care and outcomes. Payers may use 3M CRGs to align payment incentives with clinical goals.
      To read more about how CRGs could help you, click here.

  • Public Domain Inpatient Solutions

    • Centers for Medicare and Medicaid Services (CMS) Diagnosis Related Groups (CMS DRGs) were developed for the classification of Medicare patients through the use of the CMS DRG grouper. The CMS DRG assignment is the main factor used to determine the payment for those services by allowing inpatient hospital discharges to be grouped into DRGs that aggregate cases with similar resource consumption and clinical conditions.
    • Medicare Severity Diagnosis Related Groups (MS DRGs) were developed for classifying Medicare patients with a severity-adjusted DRG methodology. The MS DRG assignment is the main factor used to determine the payment for services by allowing inpatient hospital discharges to be grouped into DRGs that aggregate cases with similar resource consumption and clinical conditions.

  • 3M Public Domain Outpatient Solution

    • Integrated Outpatient Code Editor contains the APC grouper and the Outpatient Code Editor used by the Centers for Medicare and Medicaid Services for the Medicare Outpatient Prospective Payment System (OPPS).

For more information, call 800.367.2447 or click here.