APR-DRG definition
Examples of APR-DRG in a sentence
For inpatient hospital claims, the MCOP shall use the 3M All-Patient Refined Diagnosis Related Grouper (APR-DRG) and utilize the same version that ODM uses.
For inpatient hospital claims, the MCP shall use the 3M All-Patient Refined Diagnosis Related Grouper (APR-DRG) and utilize the same version that ODM uses.
This change was measured by comparing the plan-reported costs per admit in CY 2013 to the expected costs per admit using the All Patient Refined (APR)-DRG fee schedule in effect on July 1, 2013.
If a hospital is in a Metropolitan Statistical Area (MSA) peer group and is not a Medicare designated critical access hospital, then the hospital’s APR-DRG payments are subject to a two-sided risk corridor relative to the prior DRG prospective payment system in effect prior to July 1, 2013.
As previously mentioned, an explicit adjustment has been made for changes in ODM’s inpatient APR-DRG fee schedule from the CY 2018 base experience period to the fee schedule that will be in place during CY 2020.
As previously mentioned, an explicit adjustment has been made for changes in ODM’s inpatient APR-DRG fee schedule from the 2014 base experience period to the July 1, 2015 fee schedule.
Through discussions with the Ohio Hospital Association, changes were further made to base rates for some urban hospitals by expanding the risk corridor when compared to the pre- all patient refined (APR)-DRG system — from gains/losses that were +/- 3% using the prior methodology to +/- 5% using the prior methodology.
As previously mentioned, an explicit adjustment has been made for changes in ODM’s inpatient APR-DRG fee schedule from the CY 2017 base experience period to the fee schedule that will be in place during CY 2019.
The need for total respiratory support must be documented by a copy of the UB-04 or a copy equivalent to the UB-04 with at least one of the LTC or APR-DRG codes (with the designated ICD-10-PCS procedure code) listed above or a copy of the member’s admission history and physical exam, discharge summary, physician and nurse’s notes that pertain to the member’s ventilator use.
As previously mentioned, an explicit adjustment has been made for changes in ODM’s inpatient APR-DRG fee schedule from the CY 2016 base experience period to the fee schedule that will be in place during CY 2018.