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Risk adjustment initiatives in the Northeast

Many risk adjustment initiatives are happening across your region. Some apply to payment, some to reporting and still others to quality. Find out what initiatives are impacting you.

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  • To see the current initiatives affecting your organization, click your state.
National
3M™ APR DRGs Cost Weights and Trims
CMS Inpatient Prospective Payment System
CMS Long Term Care
CMS Inpatient Psychiatric Facilities
Read more.
Connecticut

3M™ APR DRGs

Read more.
District of Columbia
3M™ APR DRGs
3M™ Enhanced APGs
Read more.
Massachusetts
3M™ APR DRGs
3M™ Enhanced APGs
3M™ Potentially Preventable Readmissions (PPRs)
3M™ Population-focused Preventables
Read more.
Maryland
3M™ Enhanced APGs
3M™ APR DRGs
3M™ Potentially Preventable Complications (PPCs)
Read more.
New Jersey

3M™ APR DRGs

Read more.
New York
3M™ APR DRGs
3M™ Clinical Risk Groups
3M™ Enhanced APGs
3M™ Potentially Preventable Events
Read more.
Pennsylvania

3M™ APR DRGs
3M™ Population-focused Preventables

Read more.
Rhode Island

3M™ APR DRGs

Read more.
Virginia

3M™ APR DRGs
3M™ Enhanced APGs

Read more.
West Virginia

No current initiatives

Vermont

No current initiatives

New Hampshire

No current initiatives

Deleware

No current initiatives

Maine

No current initiatives

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  • 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 is available in your state.


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  • National grouping soutions

    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.
    • Interested in licensing these methodologies? Let our team help.

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  • Massachusetts

    Massachusetts

    • Initiative: 3M™ Population-focused Preventables Software, Potentially Preventable Admissions module for Medicaid
      Type: Payment Adjustment
      Implemented: April 2017
    • Initiative: 3M™ Population-focused Preventables Software, Potentially Preventable Emergency Department Visits module for Medicaid
      Type: Payment Adjustment
      Implemented: April 2017
    • Initiative: 3M™ APR DRGs for Medicaid
      Type: Payment
      Implemented: October 2007
    • Initiative: 3M™ Enhanced APGs for Medicaid
      Type: Payment
      Implemented: December 2016
    • Initiative: 3M™ Potentially Preventable Readmissions for Medicaid
      Type: Payment
      Implemented: October 2011
    • Interested in licensing these methodologies? Let our team help.

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  • Maryland

    Maryland

    • Initiative: 3M™ APR DRGs for Health Services Cost Review Commissions
      Type: Payment adjustment
      Implemented: December 2004
    • Initiative: 3M™ Enhanced APGs for Health Services Cost Review Commissions
      Type: Payment Adjustment
      Implemented: December 2004
    • Initiative: 3M™ Potentially Preventable Complications for Health Services Cost Review Commissions
      Type: Payment
      Implemented: July 2009
    • Interested in licensing these methodologies? Let our team help.

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  • New York

    New York

    • Initiative: 3M™ Clinical Risk Groups CRGs for Medicaid Health and Recovery Plans Program
      Type: Payment Risk Adjustment
      Implemented: April 2017
    • Initiative: 3M PPEs for Medicaid MCO
      Type: Payment Adjustment
      Implemented: January 2016
    • Initiative: 3M CRGs for Medicaid MCO
      Type: Payment
      Implemented: January 2008
    • Initiative: 3M EAPGs for Medicaid MCO
      Type: Payment
      Implemented: December 2008
    • Initiative: 3M CRGs for Medicaid Managed LTC
      Type: Payment
      Implemented: January 2012
    • Initiative: 3M EAPGs for Medicaid (FS Clinics, ASC)
      Type: Payment
      Implemented: July 2010
    • Initiative: 3M APR DRGs for Medicaid (FFS, MMC, Workers Comp, No Fault)
      Type: Payment
      Implemented: December 2009
    • Interested in licensing these methodologies? Let our team help.

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  • Pennsylvania

    Pennsylvania

    • Initiative: 3M™ APR DRGs for Medicaid
      Type: Payment
      Implemented: March 2013
    • Initiative: 3M™ Population-focused Preventables Software, Potentially Preventable Admissions module for Medicaid
      Type: Payment Adjustment
      Implemented: October 2016
    • 3M™ APR DRGs for Medicaid Managed Care
      Type: Payment
      Implemented: October 2013
    • Interested in licensing these methodologies? Let our team help.

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  • Virginia

    Virginia

    • Initiative: 3M™ APR DRGs for Medicaid
      Type: Payment
      Implemented: October 2014
    • Initiative: 3M™ Enhanced APGs for Medicaid
      Type: Payment
      Implemented: April 2010
    • Initiative: 3M™ Enhanced APGs for Medicaid (Hospitals)
      Type: Payment
      Implemented: January 2014
    • Interested in licensing these methodologies? Let our team help.

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