The APR-DRG is an independent measure of severity of illness based on the ICD-9-CM medical diagnoses and procedures from the UB-92
dataset (Averill et el.
Some states, such as New York and California, have expanded the standard UB-92
to include an indication of whether or not each secondary diagnosis is present at admission.
Its camera technology features 30 million pixels-per-second throughput and 400 dpi resolution to vividly capture patient records, HCFA and UB-92
forms, lab results, photographs, charts, graphs, highlighted text and all types of correspondence.
All the commercial information systems most hospitals acquire for such profiling use the same basic data set - the UB-92
The Analyst(TM) allows users to drill down to the UB-92
level for any reported inpatient or ambulatory discharge in the state of Wisconsin, and aggregate the data to any level contained within the dataset.
The charges for ancillary services received on these days are considered covered services and should be reported on the UB-92
, but there is no provision for payment of these services.
The billing process begins with a download of data from the provider's information system, usually in the form of a print spool file containing the UB-92
or HCFA 1500 claims, and then the billing application analyzes each claim for completeness and accuracy of data.
We recommend beginning with the UB-92
and then working backward through the system.
California and New York require hospitals to report on inpatient admissions using the standard UB-92
data set but risk-adjust those data by proprietary methodologies developed by each state.
ClaimTrack is a Windows-based claims management system that provides online edits, error correction and processing for UB-92
and HCFA-1500 claims.
For billing purposes, the 15-minute increments may be used on the UB-92
claim form, since the RUG score is calculated from the MDS and not from the bill.
HCFA will match the UB-92
to the MDS and generate reports for use by fiscal intermediaries during medical review of bills.