Grouping and reimbursement

NOTE: You must obtain licenses to use both the 3M and Axion Revenue Modeling (ARM) options. When using 3M, an entity is related to a 3M-authorized site name. When using ARM, you can select any available contract.

Use the grouping and reimbursement feature to define the methodology that payers calculate against so that you can direct encounters using either 3M or Axiom Revenue Modeling (ARM) contracts to obtain expected or modeled payment amounts. Expected or modeled payment amounts are available for both 3M and ARM integrations.

Grouping and reimbursement consists of two options:

• Expected - The facility to be reimbursed based on current contract terms.

• Modeled - What-if scenarios to model groupings or reimbursements on different terms.

Benefits of grouping and reimbursements

Grouping and reimbursement provides the following benefits, enabling you to:

• Group entities and determine reimbursements that payers calculate against with 3M and ARM options.

• Use 3M to group services into payer-specific coding requirements, including inpatient Medicare Severity-Diagnosis Related Groups (MS-DRGs) and All Patients Refined-Diagnosis Related Groups (APR-DRGs), and outpatient Ambulatory Payment Classifications (APCs) and Enhanced Ambulatory Patient Groups (eAPGs).

• Use 3M to group into another payer’s coding to compare encounters across demographics.

• Calculate reimbursement for government payers using 3M DRG, APC, and eAPG-licensed schemas.

• Calculate reimbursement for commercial payers using the Axiom Contract Management robust calculation engine.