3M™ Core Grouping Software

Process claims for all patients, all payers

Running on a Microsoft® Windows®-based platform, the 3M Core Grouping Software (CGS) processes both inpatient and outpatient claims based on Medicare and non-Medicare payment methodologies. It groups, edits and estimates reimbursement for hospital-submitted patient claims, including:

• Assigning patient records to inpatient or outpatient groups
• Evaluating the accuracy and completeness of clinical data
• Identifying potential coding errors
• Verifying hospital claims for reimbursement

Customized content

3M CGS is available with a wide variety of Medicare, non-Medicare, and state payment methodologies, providing one package for your particular grouping and editing needs.

Compliant, complete edits and grouping

Prompt updates mean that 3M CGS content reflects current CMS and payer rules. The reliable inpatient and outpatient edits help providers generate cleaner claims, reduce compliance risk and reduce reprocessing. For inpatient data, 3M CGS ncompasses coding rules and guidelines from CMS, HCHS, AHA, AHIMA, and the AMA, as stipulated by the Office of Inspector General (OIG).

For outpatient data, 3M CGS features expanded edits from the CMS Outpatient Code Editor (OCE), including the National Correct Coding Initiative (NCCI) edits, and additional 3M-defined informational edits to help you improve the compliance, completeness, and consistency of your Medicare coding and reimbursement. Other edits that review coding quality, partial hospitalization for mental health, proper billing of multiple visits, HCPCS/CPT® modifiers, and more have also been added.

Accurate reimbursement calculations

The 3M Core Grouping Software includes logic consistent with the regulations to implement the defined payment rules, including those for:

• Packaging—bundling of services into significant procedure or medical APCs
• Discounting—reduces payment for a second or subsequent occurrence of significant procedure
• Wage adjustments—APC payment is adjusted by the hospital’s wage index
• Outlier payments—made for services where the cost for the service greatly exceeds the payment amount for the given service