DRG = diagnosis related group See page 93, CPL11 of the 835. My understanding of DRGs is that they are a method used to group like-claims for administrative (payment) purposes - something of a cost-control method: e.g., all normal appendectomies get paid the same. DRGs can incorporate all sorts of groups of diagnoses and treatments and (at least theoretically) be used to pay like-claims in a comparable manner.
Other definitions? Jan Root Asis Basu wrote: > DRG is not a name of a segment. Iknow I am non-contextual in the matter. I need >the help on the acronym and perhaps the semantics. > Thanks, > > Asis Basu > HIPAA EDI Compliance Analyst > Department Of Developmental Services > State Of California > 1600 9th Street Room #206 > Sacramento, CA 95814 > 916-654-2062 (Voice) > 916-654-3352 (Fax) > mailto:[EMAIL PROTECTED] > > 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. If you >have received this e-mail and attachments in error, please contact DDS-State Of >California immediately at (916) 654-2062 and delete the e-mail and its attachments >from your computer. Thank you for your attention. > > >>> [EMAIL PROTECTED] 01/15/02 08:11AM >>> > > I agree with Jan. As a provider I would need to know the DRG we were paid > on especially if it doesn't match what we submitted on the initial claim. > > Tami Leaver > Sr. Application Analyst > Medstar Information Systems > > 410-933-6905 > email: [EMAIL PROTECTED] > > > Jan Root > <janroot%uhin.com@interne To: >[EMAIL PROTECTED] > t.mhg.edu> cc: > Subject: Re: FW: Question >about returning the DRG in the 835 > 01/15/02 11:06 AM > Please respond to > transactions%wedi.org > > > > 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. > > ********************************************************************** > 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. ********************************************************************** 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.
