ForwardHealth uses the All Patient Refined Diagnosis Related Group (APR DRG) classification system to classify and calculate pricing for inpatient hospital claims, Medicare crossover claims, and HMO encounters with dates of discharge or "To" dates of service (DOS) on and after January 1, 2017. The APR DRG classification system will replace the Medicare Severity Diagnosis Related Group (MS-DRG) classification system. The MS-DRG classification system is still effective for inpatient hospital claims, Medicare crossover claims, and HMO encounters with dates of discharge or "To" DOS before January 1, 2017. Please see here for a history of the previously used MS DRGs. The APR DRG classification system:
APR DRG rates and weights that are effective on and after January 1, 2017, are published on the Hospital Rates and Weights Portal page.
Current version information and installation dates for the APR DRG Grouper, the 3M Grouper Plus Content Services (GPCS), and the EAPG grouper can be found on the Hospital Rates and Weights Portal page.
ForwardHealth conducted provider training sessions on the APR DRG classification system in October 2016. The training presentations are available below.
ForwardHealth is communicating APR DRG information to HMOs at the monthly HMO Encounter Technical meetings; however, HMOs are encouraged to check this page regularly for updated information. ForwardHealth has given HMOs the user ID and password needed to access the secure program, which contains APR DRG versions, an APR DRG calculator, and the APR DRG Definitions Manual. HMOs with APR DRG encounter questions may email them to VEDSHMOSupport@wisconsin.gov. Questions should not be sent in a secured format (e.g., Zix Email Encryption), because these messages cannot be opened for security reasons.
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