3M content for coding, grouping, reimbursement and performance measurement

Inpatient and outpatient solutions

  • Would you like access to the latest regulatory editing, grouping and reimbursement content from “the cloud?” Do you need to save time, reduce IT costs, and have real-time access to this essential federal and state regulatory content?

    When 3M business partners subscribe to 3M Grouper Plus Content Services (GPCS), 3M experts do the heavy lifting to maintain and update complex and dynamic regulatory information. The content is delivered with minimal IT effort through a web-services cloud environment, and because 3M GPCS uses industry-standard SOAP-based web services, you can integrate this content into your applications using your choice of programming languages.

    You can also reduce IT expenditures, because there’s no local software installation or the need to modify interfaces when new content is received.

    For complete details, see our fact sheet (PDF, 157 KB).

  • Are you looking for a whole new level of versatility in grouping, editing and reimbursement calculation? And have it all available on a Microsoft® Windows®-based platform?

    The 3M Core Grouping Software provides accurate and efficient grouping, editing, and calculation of expected reimbursement for inpatient and outpatient claims, Medicare and non-Medicare. This very popular solution is used by providers, payers, fiscal intermediaries, and state and federal agencies.

    It can operate in batch mode (to process high volumes of claims data) or in "interactive mode" (to let you enter, modify, and process individual claims and review the output from the grouping and reimbursement calculation). Solutions are also available for hospitals (inpatient and outpatient services), physicians, and renal dialysis centers.

    For complete details, see our fact sheet (PDF, 484 KB).

Episodes of care solution

  • Do you or your clients need help with contracting, disease management, provider profiling, or quality and outcomes measurement? Do you want to analyze patient data over time and across health care settings?

    The 3M Clinical Risk Grouping Software is a grouper that measures an individual’s chronic illness burden using inpatient, ambulatory, and pharmacy data over a period of time and provides the basis for predicting future use of medical services. Managed care organizations, researchers, consultants, epidemiologists, and government health policy leaders can all use the 3M Clinical Risk Grouping Software to group patient data as the basis for evaluating patient populations for effective risk adjustment, managing resources for delivering care, defining episodes and projecting future costs of care.

    Learn more about 3M CRGs.

Inpatient reimbursement / performance measurement

  • Are your clients trying to accurately compare their hospital service lines, individual physician performance, and patient outcomes? Do they need a tool that can deliver an apples-to-apples comparison?

    This 3M-proprietary grouping software is based on the 3M™ APR DRG Classification System, which adjusts data to reflect a patient's severity-of-illness and risk-of-mortality, so you can achieve a common measurement across disparate patient types. The result? Improved quality and more efficient operations.

    Learn more about 3M APR DRGs.

  • Do your clients need help accurately reporting on potentially preventable readmissions results? Do they want to understand the preventable readmission patterns in their hospitals, or address a negative public report card?

    The 3M PPR Grouping Software:

    • Uses administrative data and clinical logic to determine whether a readmission is clinically related to a previous admission
    • Is a batch grouping application that can be integrated into a hospital's information system
    • Adjusts patient data for risk using the 3M APR DRG Classification System for more accurate analysis
    • Requires no clinical abstracting from patient charts or manual gathering of clinical information

    Learn more about 3M PPRs.

  • Do your provider clients need help identifying potentially preventable complications (PPCs)? Are they ready to meet requirements of a "pay-for-performance" initiative such as the CMS hospital-acquired conditions (HACs)?

    The 3M PPC Grouping Software is available as a module in the 3M™ Core Grouping Software and the 3M™ Grouper Plus System and can be integrated into a provider's information system.

    The 3M PPC Grouping Software:

    • Uses administrative claims data (including the present on admission, or POA, indicator) to identify PPCs and CMS HACs
    • Requires no clinical abstracting from patient charts or manual gathering of clinical information
    • Leverages the 3M™ APR DRG Classification System to cover all patients for more comprehensive and precise analysis

    Learn more about 3M PPCs.

Outpatient reimbursement / performance measurement

  • Do your clients need to improve their analysis and real-time management of outpatient reimbursement? Do they want a tool that can include all services, even supplies and drugs?

    This 3M-proprietary methodology addresses all population groups to better reflect current clinical care complexities, practices, and cost structures for outpatient services. It is being adopted by many states and payers to simplify and streamline the outpatient prospective payment process. It includes significant clinical enhancements from the original ambulatory patient groups (APGS) and represents an alternative to the CMS OPPS, which uses ambulatory payment classifications (APCs).

    The 3M EAPG System:

    • Is designed to cover complete populations and is not focused on Medicare beneficiaries
    • Is used for the full range of ambulatory settings (e.g., hospital outpatient departments, ASCs, free-standing clinics, dialysis centers, etc.) creating a common system for what can be competing care settings
    • Provides a methodology for equitable reimbursement
    • Does not rely on a series of fee schedules, simplifying implementation and ongoing support, as well as providing better financial management than APCs

    Learn more about 3M EAPGs.

Payment and reimbursement calculation solutions

Today, 3M supports grouping, editing, and reimbursement configurations for over 50 federal, state, and commercial payer and reporting organizations implemented for payment, quality and public reporting and also provides access to reimbursement calculations for federal, state, and commercial payers.

In addition, 3M offers Pricer Tables, which are pre-populated payment schedules that include provider-specific data for all applicable providers for the current year and previous years. These are created, maintained, and updated to reduce your time spent on configuration and research.

Supported payment and reimbursement solutions are listed in the fact sheet for the 3M™ Core Grouping Software (PDF, 255.33 KB).

  • Do you need a reimbursement calculation solution for a unique payment methodology?

    The 3M Inpatient and Outpatient Payment Calculation Toolkits allow payer and provider clients to calculate expected reimbursement for hospital inpatient and outpatient payment methodologies that are not supported within the 3M Core Grouping Software, the 3M Grouper Plus System, or equivalent mainframe solutions.

    If you do not see a supported solution that meets your needs or want more information on these toolkits, contact us.

  • Do you need a solution for the newly implemented prospective payment system for renal dialysis performed by hospitals and free-standing dialysis centers?

    3M recently introduced the Medicare Renal Dialysis Facility reimbursement scheme for pricing outpatient hospital and independent renal dialysis claims (Bill Type 072X). This reimbursement scheme is based on Medicare ESRD regulations effective for "through" dates on or after 01/01/2009.

    Though this reimbursement scheme does not use grouping, you should set up your schedule to use the OCE/APC grouper to ensure you receive the appropriate edits. This software solution addresses the complexities of Medicare's newly implemented prospective payment system for these services.

  • Do you need a solution for calculating expected reimbursement for professional claims?

    PCER includes all the necessary edits, specialized payment rules, and fee files required to accurately calculate expected reimbursement for professional claims under the Medicare Physician Fee Schedule. It addresses all specialties and can be customized to support other similar payment methodologies.

    For each professional claim processed, output from the Professional Claims Editor (PCE) shows edits, payment indicators (e.g., adjustment flags, discounts, a not-payable-by-Medicare, etc.), and Professional Claims Reimbursement (PCR) estimated reimbursement.

    Contact us for more information.

Coding solutions for auditing / outsourced coding

  • Are you looking for an accurate, specific coding system updated with current regulations and comprehensive edits? Would you like to work with a coding system and company that provides both the training and tools you need?

    The industry-leading 3M Coding and Reimbursement System incorporates coding, grouping, editing, reimbursement, and analyzer capabilities. The system allows HIM professionals to clinically evaluate the health record and identify the most appropriate ICD-9 and CPT®/HCPCS codes.

    Expert, proprietary logic identifies CCs and MCCs in the coding path, and coders have immediate access to industry-standard coding reference materials integrated within the software itself.

    Today, the 3M™ Codefinder™ Software has an ICD-10 comparison tool that allows the coder to see the equivalent ICD-10-CM/PCS code(s) for an ICD-9-CM code listed on the Coding Summary screen. As records are coded today, coding professionals can begin to see the difference the new classification system will make and start to familiarize themselves with the changes that are coming.

    The system is available as a Microsoft® Windows® application or a web-based edition and also offers a wide selection of groupers and reimbursement formulas to support many federal and state payment and quality initiatives.

    Learn more about the 3M Coding and Reimbursement System

*CPT® is a registered trademark of the American Medical Association.