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., 1997; Welton & Halloran, 2000).
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.
In all, more than 30 states began collecting UB-92
data on inpatients, but what they did with those data, and how they risk-adjusted the outcomes (length of stay, charges, and mortality rates) defined by those data varied widely from state to state.
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.
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.
SLMC awarded the contract to Critical Info Solutions, a channel partner of Captiva Software Corp., for implementation of ClaimPack, claims processing software that automates data and image capture from complex paper and electronic HCFA and UB-92
* HCFA will match the UB-92
to the MDS and generate reports for use by fiscal intermediaries during medical review of bills.
They also can be used to capture HCFA 1500 and UB-92
health claims and unstructured documents such as invoices, freight bills and Explanations of Benefits.
This means that the facility is not responsible for including them on the SNF UB-92
claim form to bill Medicare Part A.