All Patient Refined DRGs (APR DRGs)
NYS Medicaid's newly adopted APR-DRGs are significantly more complex than previous
payment systems. Hospitals need to ensure that they are capturing the proper SOI to ensure accurate reimbursement. The APR grouper logic and relative weights are very different than the familiar MS and AP DRGs. There are new areas where improved clinical documentation and coding can lead to higher SOI levels. Coding strategies that were effective
under other DRG grouping systems need to be updated. For
The designation of diagnoses as CCs / Major CCs under both
MS DRGS and AP DRGs is not related to or consistent with the
Severity of Illness (SOI) levels assigned to diagnoses under
Many diagnoses that impact SOI were not considered CCMCCs
under the previous AP and MS DRG systems.
It is the cumulative impact of multiple codes which will
APR-DRGs each have 4 distinct severity of illness (SOI)
levels that drive reimbursement. Complete and specific documentation
is more important than ever to capture the multiple diagnoses
needed to achieve a high SOI.
Most hospitals did not focus their documentation improvement
efforts on services like pediatrics, uncomplicated deliveries
and normal newborns because there was minimal opportunity to
affect DRG assignment under the AP and MS DRG systems . However, these services tend
to have high Medicaid utilization and now have increased potential
for improvement under APR-DRGs.
Contact us today to customize your APR-DRG strategy.
PCS is now offering a Complimentary Customized
APR-DRG Hospital Profile. To view a sample chart about
Severity of Illness Distribution from this profile
How Do You Compare to Top Performing Hospitals?
We have compared hospitals' SOI mix by the most important
product lines to top performing peers. Reporting secondary conditions and assigning the correct diagnosis codes is critical
to accurate DRG and SOI assignment. Higher SOIs lead to higher
Our team will identify your opportunities - even in areas
not traditionally the focus of your previous Clinical Documentation
Improvement Initiatives. Understand your current DRG and
SOI mix with:
- Data Analysis, Departmental Review, and Reimbursement
- Coding and Billing Audits
- Operational Assessments
Once you understand how APR-DRGs affect your hospital, PCS will help you:
- Establish targets and focus areas
- Educate your team
- Monitor your progress