APR-DRG (and anything peds or ob)
Hi,
This is an ever increasing subject--"what can you tell me about APR-DRG?' I am hoping I can eventually come up with a better answer than "it's really complicated!"
What little I know is this (AND CORRECT ME WHERE I AM OFF!):
APR-DRG is:
* used by many (and probably more) states for their Medicaid population.
*supposed to be more specific to the individual's comorbidities to more accurately reflect their true acuity
*?? there is some talk about CMS moving to this system in the future (though just talk at this point)
Anyone who has any material (even if you may have given it before) that is willing to email I really appreciate it .
* on APR-DRG
* pedicatric conditions that are often missed in documentation and/or increase apr-drg
*OB conditions that are often missed or effect APR-DRG
Also if anyone knows of any courses, seminars that focus on this topic--Does anyone have a plan for learning this better? Or is it mostly playing the the grouper?
Oh and one more thing...
Let say in out standard DRG system when two conditions equally meet for PDX and either can be sequenced first for reimbursement--- if the same is true with APR-DRG could a different sequencing actually give a more preferred reimbursement? Do any facilities evaluate this based on knowing the actual payment system for that patient or does that muddy the mater too much for coding? AND if that is true has anyone every attempted to address this?
I know there are a lot of questions in this post so feel free to chime in on one or as many things as you can share. Or email me directly if have any literature or websites for courses.
Thanks so much!!!
Ann Donnelly,RN,BSN,CCDS
annnd2009@gmail.com
This is an ever increasing subject--"what can you tell me about APR-DRG?' I am hoping I can eventually come up with a better answer than "it's really complicated!"
What little I know is this (AND CORRECT ME WHERE I AM OFF!):
APR-DRG is:
* used by many (and probably more) states for their Medicaid population.
*supposed to be more specific to the individual's comorbidities to more accurately reflect their true acuity
*?? there is some talk about CMS moving to this system in the future (though just talk at this point)
Anyone who has any material (even if you may have given it before) that is willing to email I really appreciate it .
* on APR-DRG
* pedicatric conditions that are often missed in documentation and/or increase apr-drg
*OB conditions that are often missed or effect APR-DRG
Also if anyone knows of any courses, seminars that focus on this topic--Does anyone have a plan for learning this better? Or is it mostly playing the the grouper?
Oh and one more thing...
Let say in out standard DRG system when two conditions equally meet for PDX and either can be sequenced first for reimbursement--- if the same is true with APR-DRG could a different sequencing actually give a more preferred reimbursement? Do any facilities evaluate this based on knowing the actual payment system for that patient or does that muddy the mater too much for coding? AND if that is true has anyone every attempted to address this?
I know there are a lot of questions in this post so feel free to chime in on one or as many things as you can share. Or email me directly if have any literature or websites for courses.
Thanks so much!!!
Ann Donnelly,RN,BSN,CCDS
annnd2009@gmail.com