Classification and grouping
Healthcare providers generate volumes of patient information that result in coded medical records. This coded data is valuable to providers, regulators, payers and consumers who want to understand the value of patient care. A careful analysis of an organization’s coded data can provide insights into patient mix, expected reimbursement and quality outcomes.
Keep up with dynamic regulatory changes
3M classification and grouping methodologies for both inpatient and outpatient records can be used to help organizations review coded data and claims to:
- Validate codes
- Calculate payment based on payer rules and regulations
- Apply CMS edits, such as MCE and OCE, as well as 3M proprietary edits
- Calculate relative weights to support case mix analysis
Accurately represent patient care
3M classification and grouping methodologies can help hospitals and care providers:
- Accurately represent patient severity of illness (SOI) and risk of mortality (ROM)
- Risk adjust and assign patient records to diagnosis related groups (DRGs)
- Track potentially preventable events, such as avoidable readmissions and hospital-acquired conditions
Solutions for classification and grouping
3M APR DRGs provide a clinically based measurement system to help organizations adjust for patient SOI and ROM, providing more relevant inpatient data for quality, analytics and public reporting.
Used by payers, managed care companies, claims review companies and other payers of provider-submitted patient claims, 3M Clinical Claims Editor Software evaluates groups of inpatient medical records for accuracy and completeness, identifies potential coding errors and verifies hospital claims for reimbursement.
The 3M Clinical Risk Groups (CRGs) are a risk-adjustment tool and clinically-based classification system used to measure a population’s burden of illness, using standard claims forms for both inpatient and outpatient care.
This grouping software for providers, payers, managed care companies, claims review companies and other payers of hospital-submitted patient claims evaluates groups of inpatient or outpatient medical records for the accuracy and completeness of clinical data. It identifies potential coding errors and verifies hospital claims for reimbursement.
The 3M PPR Grouping Software helps identify readmissions that are potentially preventable by means of a powerful 3M PPR clinical methodology and clinical logic that determine whether a readmission is clinically related to a previous admission.
The 3M PPC Grouping Software also applies sophisticated 3M clinical logic to determine whether conditions were potentially preventable, using such criteria as patient characteristics, reason for admission, procedures, and the interrelationships between underlying medical conditions. 3M PPCs cover 64 different potentially preventable complications and identify CMS hospital-acquired conditions (HACs).
Both 3M PPCs and 3M PPRs rely on the 3M™ APR DRG Classification System as a foundation for a more accurate level of analysis by adjusting for patient severity of illness and risk of mortality.
3M classification and grouping software is available as integrated and embedded solutions to group and edit outpatient claims using the CMS Ambulatory Payment Classifications (APCs) and 3M™ Enhanced Ambulatory Patient Groups (EAPGs) as specified by outpatient prospective payment systems.