DRG is "Diagnosis Related Group". It's how the Medicare program pays inpatient hospital claims.
----- Original Message ----- From: "Pat Van Dyke" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Saturday, January 19, 2002 1:15 PM Subject: Re: FW: Question about returning the DRG in the 835 > I am new to this discussion group....The DRG issue is concerning for our organization as well. We may find a DRG that is more appropriate based on the situation compared to the DRG that is sent to us by the institution. In the IG's there is a theme to reporting back not only the original information i.e. billed charge, procedure code etc. but also the changes and why they were made. It seems that this should hold true for the DRG as well. Is there any value in going to the X12 committee who developed this for discussion? > > Jan Root wrote: > > > 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. > > > > ********************************************************************** > 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.
