Diagnosis Related Grouping (DRG) Pricing

Pre- and Post Pay Inpatient Claims

Unparalleled Systems

DataMetrix provides several types of pricing services including pre- and post pay DRG pricing. Our proprietary Claims Analysis Secure Engine (CASE™) has been customized by our IT specialists with the development input and cumulative knowledge of our team of clinical and medical experts.

Embedded into CASE™, the DRG pricer uses CMS raw data tables to correctly price DRG claims. When CMS releases updated raw data tables, the DataMetrix pricer is automatically updated within 24-48 hours. CASE™ automatically selects the appropriate CMS version using a patient’s discharge date to ensure the correct grouping, editing and pricing are done. Knowing that it can be very difficult to find the correct pricer, CASE™ stores a five-year history of CMS versions to ensure all claims are priced correctly.

Complete Methodology

We have integrated all functions into a single system to eliminate pricing errors. Unlike most DRG Pricing services, we dig deeper into coding rules and ensure accuracy by keeping a 5-year history of CMS versions.

The integrated Grouper, Editor, Pricer within CASE™ encompasses all aspects that will affect the final pricing of a claim. Where other pricing services will simply price a DRG, DataMetrix takes into account all diagnosis and procedure codes, along with other factors such as POA indicators, to determine the correct pricing. This ensures not only that the DRG is priced correctly, but that it is also the appropriate DRG to begin with. The Grouper, Editor, Pricer allows for quick batch processing or can even be used on a claim-by-claim basis.

Diagnosis Related Grouping (DRG) Pricing

Pre- and Post Pay Inpatient Claims

Unparalleled Systems

DataMetrix provides several types of pricing services including pre- and post pay DRG pricing. Our proprietary Claims Analysis Secure Engine (CASE™) has been customized by our IT specialists with the development input and cumulative knowledge of our team of clinical and medical experts.

Embedded into CASE™, the DRG pricer uses CMS raw data tables to correctly price DRG claims. When CMS releases updated raw data tables, the DataMetrix pricer is automatically updated within 24-48 hours. CASE™ automatically selects the appropriate CMS version using a patient’s discharge date to ensure the correct grouping, editing and pricing are done. Knowing that it can be very difficult to find the correct pricer, CASE™ stores a five-year history of CMS versions to ensure all claims are priced correctly.

Complete Methodology

We have integrated all functions into a single system to eliminate pricing errors. Unlike most DRG Pricing services, we dig deeper into coding rules and ensure accuracy by keeping a 5-year history of CMS versions.

The integrated Grouper, Editor, Pricer within CASE™ encompasses all aspects that will affect the final pricing of a claim. Where other pricing services will simply price a DRG, DataMetrix takes into account all diagnosis and procedure codes, along with other factors such as POA indicators, to determine the correct pricing. This ensures not only that the DRG is priced correctly, but that it is also the appropriate DRG to begin with. The Grouper, Editor, Pricer allows for quick batch processing or can even be used on a claim-by-claim basis.