What is the current version of APR DRG?

Effective for discharges on or after July 1, 2018, version 34 of the 3M All Patient Refined Diagnosis Related Groups (APR-DRG) grouper will be utilized for Medicaid, Workers Compensation and No-Fault.

What is APR DRG grouper?

All Patients Refined Diagnosis Related Groups (APR DRG) is a classification system that classifies patients according to their reason of admission, severity of illness and risk of mortality.

What does a DRG grouper do?

The DRG-Grouper is used to calculate payments to cover operating costs for inpatient hospital stays. Under the inpatient prospective payment system (IPPS) each individual case is categorized into a diagnosis-related group – DRG.

How is APR DRG calculated?

Just as with MS-DRGs, an APR-DRG payment is calculated by using an assigned numerical weight that is multiplied by a fixed dollar amount specific to each provider. Each base APR-DRG, however, considers severity of illness and risk of mortality instead of being based on a single complication or comorbidity.

What is the difference between DRG and APR DRG?

AP-DRGs are similar to DRGs, but also include a more detailed DRG breakdown for non-Medicare patients, particularly newborns and children. The APR-DRG structure is similar to the AP-DRG, but also measures severity of illness and risk of mortality in addition to resource utilization.

Who owns APR DRG?

A highly enhanced extension of the basic DRG concept, the 3M APR DRGs provide a comprehensive view of the patient population and were developed by the 3M Clinical and Economic Research Department, the Children’s Hospital Association and several physician groups.

Did 3M create APR DRG?

Does Medicare use APR DRG?

Medicare uses Medicare Severity-Diagnostic Related Groups (MS-DRG), as do many private payers, but some may choose to use a modified reimbursement payment methodology. The All Patient Refined DRG (APR-DRG) system was developed by 3M™, and in order to use this payment methodology, you need access to its APR-DRG grouper.

Do DRGs save money?

According to the studies conducted on the issue, there is little evidence that DRG payment system is responsible for that. However, it is likely that the DRG payment system has encouraged the shift to outpatient care from traditional inpatient care, which is generally considered cost saving.

What is the difference between APR DRG and DRG?

What is the 3M APR DRG grouping logic for payers?

3M APR DRG grouping logic is the same for every payer, although different payers choose different configuration options and may follow different update schedules. Each payer that uses 3M APR DRGs makes its own decisions about prices and payment policies.

What is the relative weight in the DRG?

The relative weight reflects the average hospital resource use for a patient in that 3M APR DRG relative to the average hospital resource use of all inpatients. 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.

What if a claim does not group to an APR-DRG?

In addition, since the grouping is developed by 3M using clinical logic, if a claim does not group to an APR-DRG as the provider expects it to group, the provider will need to contact 3M to discuss the grouping logic.

Are the APR-DRGs different for V33 than V31 and V32?

Since there are no changes to the APR-DRGs in v33 as compared to v31 and v32, the APR-DRG weights and outlier thresholds that were effective July 1, 2014 will remain in effect for the payment of these claims.