I think we are a victim of our vocubulary (yet again!). This is not 'bundling' in the sense of pages 25 - 27. DRG 'bundling' is 'what DRG do I get out of my DRG bundling software?' Many providers and payers own DRG bundling software (yes, providers are often required to submit a DRG on a claim). It is used to determine the appropriate DRG for a given set of services.
This is a 'which DRG do I put in the 835?" question. The DRG submitted by the provider or the DRG used by the payer to pay the claim? I think the answer is the DRG used to pay the claim. That way the provider can compare their DRG with the payer's DRG. If there is a disagreement about the DRG (and hence the payment), then that can be easily identified and resolved. Other thoughts? j Jonathan Fox wrote: > I would think the explanation of bundling and unbundling on pg 25 - 27 of the 835 >Implementation Guide should help, regardless of whether or not the claim was >institutional or professional or dental. > > Jon Fox > eCommerce Analyst > Independent Health > > CONFIDENTIALITY NOTICE. This e-mail and attachments, if any, may contain >confidential information which is privileged and protected from disclosure by Federal >and State confidentiality laws, rules or regulations. This e-mail and attachments, >if any, are intended for the designated addressee only . If you are not the >designated addressee, you are hereby notified that any disclosure, copying, or >distribution of this e-mail and its attachments, if any, may be unlawful and may >subject you to legal consequences. If you have received this e-mail and attachments >in error, please contact Independent Health immediately at (716) 631-3001 and delete >the e-mail and its attachments from your computer. Thank you for your attention. > > >>> "Tucci-Kaufhold, Ruth A." <[EMAIL PROTECTED]> 01/14/02 04:47PM >>> > To the group ... > > Does anyone have an answer for this question? > > > Ruth Tucci-Kaufhold > UNISYS Corporation > 4050 Innslake Drive > Suite 202 > Glen Allen, VA 23060 > (804) 346-1138 > (804) 935-1647 (fax) > N246-1138 > [EMAIL PROTECTED] > > -----Original Message----- > From: McLaughlin, Mark [mailto:[EMAIL PROTECTED]] > Sent: Thursday, January 10, 2002 3:00 PM > To: Tucci-Kaufhold, Ruth A. > Subject: FW: Question about returning the DRG in the 835 > > Another one. > > > Mark > > > > Mark McLaughlin > > Regulatory Policy Analyst > > McKesson > > 700 Locust St. Suite 500 > > Mail stop IADU-7 > > Dubuque, IA 52001 > > (563) 557-3654 phone > > (563) 557-3334 fax > > [EMAIL PROTECTED] > > Confidentiality Notice: This e-mail message, including any attachments, is > for the sole use of the intended recipient(s) and may contain confidential > and privileged information. Any unauthorized review, use, disclosure or > distribution is prohibited. If you are not the intended recipient, please > contact the sender by reply e-mail and destroy all copies of the original > message. > > > > > -----Original Message----- > From: Falbowski, Ellen [ mailto:[EMAIL PROTECTED] > <mailto:[EMAIL PROTECTED]> ] > Sent: Wednesday, January 09, 2002 9:47 AM > To: [EMAIL PROTECTED] > Subject: Question about returning the DRG in the 835 > > The note on the CLP11 says, "This data element is specific to institutional > claims and adjudication considers the DRG." > > My question is, if a payer changes the DRG during the course of adjudicating > > the claim, which DRG should be returned in the 835: the one submitted in > the 837I (in the 2300: HI*DR), or the one that was derived by the payer? > > The IG does not seem to specify. Is there a common practice? > > Thanks. > > ********************************************************************** > To be removed from this list, send a message to: > [EMAIL PROTECTED] > Please note that it may take up to 72 hours to process your request. > > ********************************************************************** > To be removed from this list, go to: >http://snip.wedi.org/unsubscribe.cfm?list=data_review > and enter your email address. > > ********************************************************************** > To be removed from this list, send a message to: [EMAIL PROTECTED] > Please note that it may take up to 72 hours to process your request. ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request.
