National risk adjustment

Many risk adjustment initiatives are happening across the country. Some for payment, some for reporting and still others for quality. Find out what risk adjustment methodologies 3M offers nationwide.

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National

The 3M clinical grouping solutions calculate expected reimbursement using predefined logic and a custom rate schedule. You can define the parameters—hospital values, statistics files, and other reimbursement variables—governing payment processing of your patient claims. Look below to find out what national groupers are available.


  • National

    3M software also allows hospitals and other interested parties to model grouping and pricing software used by national payers. The software considers regional and hospital-specific factors such as wage areas and graduate medical education payments.

    The Centers for Medicare & Medicaid Services (CMS) Inpatient Prospective Payment System – CMS DRGs and Medicare Severity Diagnosis Related Groups (MS-DRGs) – were developed for classifying claims for Medicare patients in acute care hospitals, long-term care hospitals (LTCHs) and inpatient psychiatric facilities.

    The Centers for Medicare & Medicaid Services (CMS) Outpatient Prospective Payment System – CMS Ambulatory Payment Classifications (APCs).

    The TRICARE Inpatient and Outpatient Prospective Payment System -- Developed and maintained by 3M for the Department of Defense (DoD), this system includes additional DRGs not related to the Medicare population and is used by the Department of Veterans Affairs and DoD facilities.


Want to learn more about 3M patient classification methodologies?

Want to get to know our methodologies a little better? Read up on the latest.

  • Doctor with a boy
    3M™ All Patient Refined DRGs (APR DRGs)

    3M APR DRGs use standard patient discharge information to classify patients into clinically meaningful groups, then into four severity-of-illness and four risk-of-mortality subclasses.

    3M APR DRG fact sheet (PDF, 84 KB)

    3M APR DRG eGuide (PDF, 263 KB)

  • Outpatient hospital sign
    3M™ Enhanced Ambulatory Patient Grouping (EAPGs) System

    3M Enhanced APGs provide an up-to-date framework for analyzing and managing outpatient care, giving health care providers a powerful tool that captures changes in clinical practice and resource use.

    3M Enhanced APG fact sheet (PDF, 96 KB)

  • Doctor giving a shot to a patient
    3M™ Clinical Risk Grouping (CRG) Software

    3M CRGs are a categorical clinical model that is used to assign each patient to a single, mutually exclusive risk category.

    3M CRG fact sheet (PDF, 100.11 KB)

    3M CRG Real Results eGuide (PDF, 218 KB)

  • Doctor taking a patient's blood pressure
    3M solutions for potentially preventable events

    3M can help you manage the full spectrum of potentially preventable events (PPEs), including hospital admissions, readmissions, complications, ED visits and ancillary services.

    3M solutions for potentially preventable events fact sheet (PDF, 83 KB)

    3M population health and potentially preventable events eGuide (PDF, 822 KB)

  • Grouping, editing and pricing

    3M now offers a complete suite of solutions for grouping, editing and pricing logic, and data you will need to accurately calculate payment for all care settings.

  • 3M grouper applications
    3M offers all the content you need to price Medicare and Medicaid inpatient or outpatient claims. You can single-source groupers, edits, pricing logic and provider rate tables directly from us.
  • 3M™ Inpatient Psychiatric and Facility DRG software products
    Designed to integrate 3M's market leading coding, grouping and reimbursement technology, inpatient psychiatric and facility DRG software products help both acute care hospitals with inpatient psychiatric units and standalone mental health hospitals meet the requirements mandated by the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS).

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