DRG-PC For 95/XP
Product Pricing and License Information
DRG-PC For 95/XP is a DRG Calculation, Analysis, and Reimbursement Calculation application for:
- Hospital medical records
- Claims processing applications
- Data Warehousing and data analysis
- Claim review and compliance auditing
- Repricing and much more
DRG-PC For 95/XP includes rich features for DRG Calculation and Reimbursement Optimization. The unparalleled flexibility of DRG-PC with multiple input/output modes, Interactive, Batch, and command-line processing modes make it the ideal tool for any health care environment.
DRG-PC For 95/XP is available in multiple formats:
- Standard version - contains 2 years of DRG calculation specifications
- Enhanced Version - contains 5 years of DRG calculation specifications
- Special versions for our European customers that need a specific version of the CMS DRG specifications
PRICERActive™ Medicare Reimbursement Components have been integrated with DRG-PC For 95/XP to provide stand-alone DRG calculation and detail Medicare DRG Reimbursement Calculation. Calculate an estimated Medicare reimbursement for any Medicare hospital in the U.S.! Request a Free 30-day Trial Version of DRG-PC with PRICERActive to download.
Features of DRG-PC For 95/XP:
DRG Calculation
DRG Weight/Reimbursement Optimization
DRG Reimbursement Calculation System
Multiple Updateable DRG Weight Tables
Data Validation
Data Entry
Length of Stay Computation
Error Processing Subsystem
Data Entry Modes
DRG Processing Modes
Output Options
DRG-PC Reports
DRG/MDC Reference
Help Screens
Case History LogDRG-PC For 95/XP is simply the most versatile DRG Calculation software available today!
DRG-PC For 95/XP calculates the Diagnosis Related Group (DRG) according to the CMS specifications used by Medicare. DRG processing for two fiscal years is included. The patient age, sex, discharge status, diagnosis and procedure codes are used in the calculation process. The DRG, MDC, DRG Weight, DRG Average Length of Stay, and influencing codes are returned after processing. The accuracy of the DRG calculation process is a hallmark of DRG-PC For 95/XP.
The DRG-PC For 95/XP data entry screen is formatted for logical entry of all discharge information. All required fields are clearly marked. Detail information about each field is available by accessing the Help file by pressing F1. A window containing usage information about the field, editing performed, and reporting is displayed. After all data has been entered, all elements are edited for validity. If any errors or missing data elements are noted, error messages will be displayed in the right-hand portion of the entry screen. The user must then correct the errors before proceeding.
DRG-PC For 95/XP will compute the Length of Stay (LOS) for each DRG discharge case. After the admission and discharge dates are entered on the data entry screen, the LOS is computed. The LOS is displayed on all DRG-PC output screens, reports, and is carried through to the output file generated from the File Output Option. DRG-PC computes the LOS just as Medicare will, the number of days between admission and discharge, not counting the day of discharge.
DRG-PC For 95/XP incorporates complete validation of all data elements. Patient age, sex, discharge information, and a principal diagnosis are required for each case. All diagnosis and procedure codes are edited to be valid ICD9 codes. Additional Medicare Code Edits are performed to validate diagnosis and procedures codes against patient age and sex. Diagnosis and procedure codes are edited for being applicable only to male or female patients. Diagnosis codes that fall into categories of newborn, pediatric, maternity, and adult diagnoses are validated against the patient age. A series of edits are also performed to exclude manifestation codes, non specific codes, and E-codes as principal diagnosis. All the above edits are performed to Medicare specifications. The effect of this data validation is to help the user produce more accurately coded cases which will be paid in a more timely manner.
DRG-PC For 95/XP includes an error processing subsystem to help resolve difficult edit errors. If an error occurs that cannot be immediately resolved, it can be written to an internal error file for later resolution. This facility saves re-keying data and serves as a tracking mechanism for cases in process. Cases can be recalled from the error file to be re-processed after further research or verification is performed. Case profiles can be printed and unwanted cases can be deleted from the error file.
DRG-PC For 95/XP incorporates multiple data entry to provide flexibility and adaptability to many environments. These data entry modes are summarized below:
DRG Single Case Entry Mode
Single Case Entry Mode allows the user to enter and process a single patient discharge. Data is entered via the screen and is edited for validity. Help information, including data edit specifications, is available for each field on the data entry screen . After data has been entered and validated, DRG processing is performed. Processing is performed in Interactive Mode. DRG analysis options include Automatic DRG Weight Optimization or standard DRG processing. Once DRG processing is complete, the user can edit and re-process the case or proceed to the next. From Single Case Entry Mode the user can print a Physician Attestation Form for the completed case.
DRG Multi-Case Entry Mode
Multi-Case Entry Mode allows the user to enter and process multiple patient discharges. Data is entered via the screen and is edited for validity. Help information, including data edit specifications, is available for each field on the data entry screen. After all cases have been entered and validated, DRG processing is performed. Multiple processing options permit the user to process cases interactively or in a batch mode. DRG analysis options include Automatic DRG Weight Optimization or standard DRG processing. Once DRG processing is complete, the user can edit and re-process the case or proceed to the next. The file output option allows the user to export data. Multi-Case Entry Mode has report options of the DRG-PC Summary Report and Physician Attestation Forms for each case.
File Input Entry Mode
File Input Entry Mode allows the user to enter and process multiple DRG cases. Data is entered from an ASCII file formatted by another application or computer system. The user must specify the drive, path, and filename of the input file. After records are loaded, all input data is edited for validity and processing begins. Multiple processing options permit the user to process cases interactively or in a batch mode.
For DRG cases, DRG analysis options include Automatic DRG Weight Optimization or standard DRG processing. Once DRG processing is complete, the user can edit and re-process the case or proceed to the next.
The file output option allows the user to export data. File Input Entry Mode has report options of the DRG-PC Summary Report and Physician Attestation Forms for each case.
DRG-PC For 95/XP can operate in three different modes: Interactive, Batch, or Command line modes. These three processing modes provide differing capabilities allowing the user to utilize DRG-PC in different ways.
Interactive Mode
DRG-PC includes a feature called Interactive Case Analysis. This powerful feature is available from all data entry modes and is the default selection from DRG Multi-Case and File Input Entry Modes. This feature gives the user the ability to perform optimization analysis on each discharge case. Data elements can be modified and the case can be re-processed until desired results are achieved. This unique feature along with Automatic DRG Weight Optimization gives the user a powerful set of tools to maximize the DRG reimbursement. The full range of DRG-PC printed reports are available from Interactive Mode.
Batch Mode
DRG-PC provides a batch processing function for processing of large numbers of DRG cases. Data can input either through Multi-Case or File Input Entry Mode. DRG processing then takes place with no user intervention. Output can be directed back to the screen, printed on the DRG-PC Summary Report, or sent to an ASCII file to serve as input to another PC application. This data file can also be uploaded to a mini or mainframe computer. Physician Attestation forms can also be printed for each case.
Command Line Mode
DRG-PC DRG calculation can be invoked directly from the DOS command line. This processing mode takes advantage of the DRG-PC File Input and File Output functions. DRG-PC will input an existing formatted data file, perform editing and DRG calculation, and write results to a user-specified output file without any user interaction. In this way, DRG-PC processing can be executed from a DOS Batch file in conjunction with other PC applications. This option makes it possible to download formatted data from another computer, process the file through DRG-PC, and upload the results back to another computer for updating to patient files. Options to this process include the selection of printed reports and selection of Automatic DRG Weight Optimization or standard DRG processing.
DRG Weight/Reimbursement Optimization
DRG-PC For 95/XP includes features for Reimbursement and DRG Weight optimization, available through all data entry modes. This process will assure the highest possible reimbursement.
DRG-PC offers an Automatic DRG Weight optimization function. Each diagnosis code entered will be processed as the principal diagnosis, and the code that returns the highest weight factor will be retained. Automatic mode will not optimize to a DRG of 468 (OR Proc. unrelated to principal diagnosis). Each entry mode offers the ability to edit &reprocess the discharge case. During re-edit, the user can re-order the codes and reprocess to find the highest weight.
A complete Optimization Results Tracking system helps you manage the different combinations that help you determine the optimal reimbursement. Advanced Analysis Options allow you to further subdivide the data in the case and examine alternatives that may lead to higher reimbursement. Optimization Detail reports and a DRG Worksheet can be printed to shoe the results of the optimization activity.
A DRG Check feature examines the specifics of the DRG and MDC that has been selected and will notify you if other reimbursement optimization alternatives are possible.
DRG Reimbursement Calculation System
DRG-PC For 95/XP calculates an estimated reimbursement for each case processed. Reimbursement is calculated using the DRG Weight and the facility Blended Rate. Per Diem amounts are calculated for cases with an 02 discharge status. DRG-PC maintains multiple rate iterations, each with an effective date, for accurate pricing. A Multi-user option allows entry of a payer ID number for each case and the ability to carry rates for multiple payers. Total charges are entered for each case and DRG-PC will calculate the variance between reimbursement and charges.
Optional PRICERActive™ plug-in components duplicate the calculations used by Medicare for inpatient hospital claim payment. These modules use the same hospital-specific and geographic cost factors to compute a payment amount like your Medicare intermediary. Additional cost outlier payments are computed for applicable cases. A cost outlier threshold is calculated for each case so you know where the cost boundaries are. Calculate an estimated Medicare reimbursement for any Medicare hospital in the U.S.!Multiple Updateable DRG Weight Tables
DRG-PC For 95/XP contains a feature that allows the user to update alternate DRG Weight Tables used in the reimbursement calculation process. The Medicare DRG weight tables are standard and two additional updateable DRG Weight Tables are available. The individual DRG weights and average length of stay values can be updated for each DRG. The title you assign to each table can also be updated. These alternate DRG weight tables can be used for Medicaid, CHAMPUS, private insurance or any other payer. This feature provides great flexibility for reimbursement calculation among many payers. The selection of the DRG Weight Table to be used in pricing, is made under the Blended Rate Entry/Update function. This feature is only available under the Multi-User Pricing Option.
DRG-PC For 95/XP offers multiple Output Options for maximum flexibility. Processing results can be directed back to the screen, printed, or formatted into an ASCII file that can be passed to other applications or even uploaded to mini or mainframe computers.
From Interactive Mode for a DRG case, a detail display of processing results including diagnosis/procedure codes, code descriptions, DRG, DRG Weight, and DRG description is presented. This detail display helps the user assure that ICD9 codes selected and results achieved are accurate.
The screen output from Batch Mode displays a single line for each case processed. Included are patient account, name, diagnosis/procedure codes used, the resulting DRG and DRG Weight. The display will scroll up the screen as cases are processed. Edit error messages, if any, will be displayed on screen.
Printed reports are available for DRG cases from all entry and processing modes. Data File Output, as mentioned above, is available only from Multi-Case and File Input Entry Modes.
DRG-PC produces multiple types of printed reports. Details of each report are listed below. DRG-PC For 95/XP supports all Windows-supported printers.
Physician Attestation Form: DRG-PC will produce a detail report containing all input data and processing results. The attestation form includes descriptions of all diagnosis and procedure codes along with DRG and MDC descriptions. A certification statement and signature block are included for physician certification.
DRG-PC Summary Report: DRG-PC will produce a summary report from either the Multi-Case or File Input entry Modes. This report prints two lines of data for each case processed. All of the significant data elements are included. If any errors have occurred during batch type processing, detail error messages are printed.
DRG Worksheet: This report describes all of the reimbursement alternatives based on the various diagnosis code combinations explored during the optimization process. The worksheet can then be given to a physician to make the final determination of principal diagnosis based on the medical condition that occasioned the admission.
Optimization Detail Report. This report provides the detail information for each diagnosis code combination tried during the optimization process. The report shows the results of each diagnosis code being tried as the principal diagnosis and includes the DRG Weight, reimbursement, all diagnosis code, DRG and MDC descriptions.
DRG-PC For 95/XP includes an on-line reference to descriptions of all DRG’s and MDC’s (Major Diagnostic Category). This reference is available from the main menu. The desired DRG number is entered and the corresponding description is displayed in a viewing window. The user can then scroll the display to view other DRG descriptions. A search function is available to find a specific DRG.
The MDC display shows each MDC description. The display can be scrolled in order to view all MDC descriptions.
DRG-PC For 95/XP includes a comprehensive Help file to describe the features of the software.
DRG-PC For 95/XP includes an optional Case History Log that maintains detail of all cases processed. Numerous options are available for selecting and displaying data by patient or date criteria. Complete detail for an individual case is available by double clicking the desired record. Data in history can be selected and exported to other applications, printed reports can be generated, and cases can be re-processed.
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