3M grouping, editing and reimbursement content

Available content* for 3M’s grouping solutions: 3M™ Grouper Plus Content Services and 3M™ Core Grouping Software

Grouping

The 3M Grouper Applications solutions contain the necessary tables and logic to accurately classify inpatient and outpatient services and can be licensed with a single grouper or a combination to meet your unique needs.
 

  • Centers for Medicare & Medicaid Services (CMS) Diagnosis Related Groups (DRGs) and Medicare-severity Diagnosis Related Groups (MS-DRGs)—
  • Developed for classifying claims for Medicare patients of acute care hospitals, long-term care hospitals
  • Medicare Ambulatory Payment Classification (APC)
  • Medicare Skilled Nursing Facility (SNF)
  • Medicare Home Health
  • TRICARE DRG—Developed and maintained by 3M for the Department of Defense (DoD), this includes additional DRGs not related to the Medicare population
  • TRICARE APC
  • 3M™ All Patient Refined DRGs (APR DRGs)—Developed exclusively by 3M to significantly improve the DRG classification by incorporating four levels of severity of illness and risk of mortality
  • 3M™ Enhanced Ambulatory Patient Grouping (EAPG) System

 


Editing

CMS Medicare Code Editor (MCE) – provided with 3M’s inpatient groupers, helps you ensure that ICD-10 diagnosis and procedure codes are valid and used appropriately.

3M present on admission (POA) editor – provided with 3M’s inpatient groupers, helps you ensure that POA indicators are appropriate for the ICD-10 code they are reported with.

3M solutions for medical necessity edits – standalone editing for outpatient services which includes Medicare National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and frequency, age and gender restrictions; ICD-10 diagnosis code and modifier validity; and other state Medicaid and payer specific edits.

Outpatient edits –
 

  • The 3M versions of the Medicare APC and TRICARE APC groupers include the Medicare/TRICARE Outpatient Code Editor (OCE), National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edits (MUE). In addition, these groupers include a robust suite of proprietary edits to identify potential lost revenue, provide clarity to OCE edits and address areas that CMS examines, but which are not addressed in the public domain grouper.

  • 3M’s Medicare solutions for ambulatory surgical centers, renal dialysis facilities, professional claims, home health and hospice include both the applicable Medicare defined edits such NCCI and MUE and a robust suite of proprietary edits to ensure correct coding and billing, and identify potential lost revenue.

  • The 3M EAPGs provide editing, including NCCI, MUE, and a full suite of edits designed to ensure correct coding and billing, and identify potential lost revenue.

Reimbursement

The software calculates expected reimbursement using predefined logic and a custom rate schedule. You can define the parameters – such as hospital values, statistics files and other reimbursement variables – that will govern payment processing of your claims.

Reimbursement schemes that can be licensed include:

*Available content is current as of publication, but 3M is constantly developing new grouping, editing and reimbursement content to meet market needs. Please check with your 3M representative for the latest updates.
†Pricer Tables available.
††Pricer Tables available for outpatient only.


Population health

With 3M’s grouping and methodology solutions, you can address population health reporting and management needs and closely look at hospitalizations, readmissions, complications, ED visits and ancillary services and associated costs. 3M’s population health solutions include:
 

  • 3M™ Potentially Preventable Complications (PPC) Grouping Software - identifies in-hospital complications among secondary diagnoses in patient discharge data. Complications that may be prevented include harmful events or negative outcomes that may result from the process of care and treatment rather than from the natural progression of an underlying illness.

  • 3M™ Population-focused Preventables (PFP) Classification Methodology - identifies potentially preventable hospital admissions, ED visits and ancillary services.

  • 3M™ Clinical Risk Grouping (CRG) Software - a clinically precise tool for longitudinal disease management; ideal for provider profiling, quality measurement and outcomes improvement. 3M CRGs can help align payment incentives with clinical goals and form the basis for effective chronic disease risk adjustment.

  • 3M™ Patient-focused Episodes (PFE) Software - defines more than 500 episodes spanning inpatient and outpatient encounters and chronic and acute diseases. Supports provider profiling based on risk-adjusted clinical outcomes and computes actual costs and expected resource utilization.

  • 3M™ Potentially Preventable Readmissions (PPR) Grouping Software - uses claims data to identify hospital readmissions, or ED visits following a hospitalization that could have been prevented. PPRs are return hospitalizations that occur within a specified time interval after discharge from the hospital. PPRs may result from deficiencies in the process of care and treatment during a prior admission; from the development of a complication that became evident only after discharge; or from a lack of post-admission follow up, rather than from unrelated events.

  • CMS and HHS Hierarchical Condition Categories (HCC) - risk adjustment model used by CMS for the Medicare Advantage population and by the U.S. Department of Health and Human Services (HHS) for Affordable Care Act (ACA) plans [only available in 3M Grouper Plus Content Services (GPCS)]

Add-on modules

3M Pricer Tables provide the facility-specific variables for all applicable hospitals for calculating reimbursement for multiple providers. 3M Pricer Tables are available for the reimbursement schemes indicated above. Contact 3M for more information and the costs to license.


  • Learn more

    Health care is a dynamic industry, and 3M constantly updates its grouping, editing and reimbursement content to meet market needs. While these lists are current at the time of publication, your 3M representative can verify all the latest content additions for you.

    For more information on 3M’s grouping solutions, refer to these fact sheet pages:

    3M™ Grouper Plus Content Services

    3M™ Core Grouping Software

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