What is DRG and APR DRG?
AP-DRGs are similar to DRGs, but also include a more detailed DRG breakdown for non-Medicare patients, particularly newborns and children. The APR-DRG structure is similar to the AP-DRG, but also measures severity of illness and risk of mortality in addition to resource utilization.
What is MS and APR DRG?
6. While many state Medicaid agencies continue to pay for inpatient hospitalizations by the tried-and-true Medicare-severity diagnosis-related group (MS-DRG) system, more are turning to the all patient refined (APR)-DRG system.
What are the different types of DRGs?
There are currently three major versions of the DRG in use: basic DRGs, All Patient DRGs, and All Patient Refined DRGs. The basic DRGs are used by the Centers for Medicare and Medicaid Services (CMS) for hospital payment for Medicare beneficiaries.
What is the current APR DRG version?
10. What version of APR-DRGs was implemented? The Department implemented version 31 of APR-DRGs on October 1, 2014, which was released October 1, 2013. The Department moved to version 33 of the grouper effective October 1, 2016 and to version 35 effective October 1, 2018.
What states APR DRG?
APR-DRGs are also in use or planned for use in calculating payment by the State of Maryland, Montana Medicaid, New York Medicaid, Pennsylvania Medicaid, Rhode Island Medicaid, Colorado Medicaid, North Dakota Medicaid, and Wellmark, the BlueCross BlueShield plan in Iowa.
How many APR DRG codes are there?
3M APR DRGs can be rolled up into broader categories. The 326 base DRGs roll up into 25 major diagnostic categories (MDCs) plus a pre-MDC category. An example is MDC 04, Diseases and Disorders of the Respiratory System.
How many states use APR DRG?
27 state
Definition: 3M APR DRGs have become the standard across the U.S. for classifying hospital inpatients in non-Medicare populations. As of January 2019, 27 state Medicaid programs use 3M APR DRGs to pay hospitals, as do approximately a dozen commercial payers and Medicaid managed care organizations.
How do APR DRG systems classify patients?
All Patients Refined Diagnosis Related Groups (APR DRG) is a classification system that classifies patients according to their reason of admission, severity of illness and risk of mortality.
Who uses Apr DRGs?
As of January 2019, 27 state Medicaid programs use 3M APR DRGs to pay hospitals, as do approximately a dozen commercial payers and Medicaid managed care organizations. Over 2,400 hospitals have licensed 3M APR DRGs to verify payment and analyze their internal operations.
When did APR DRG start?
December 1990
APR-DRG Versions Since the original December 1990 release of the APR- DRGs, there have been regular major clinical updates.
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