APC Groupers and Pricers

APC GROUPER WITH OCE EDITS

APC/Grouper is the most comprehensive ambulatory grouper available and is part of a family of state­of­the­art grouper and component products by IHS. APC/Grouper determines accurate APC assignment by evaluating the diagnoses & procedure codes and grouping in accordance with OPPS regulations.

Features

  • Contains all current HCFA APCs and mandated regulations
  • Includes Medicare’s Out­Patient Code Editor (OCE), a comprehensive set of clinical code edits
  • Includes line item and claim disposition, including reasons for denial, rejection or suspension
  • Option to automatically select or specify the desired grouper
  • Ability to re­map ICD­9­CM/CPT4 codes from prior/future years to the target grouper Flexible formatting of input/output data files without programming
  • Outstanding performance in single or multi­user environments
  • True multi­platform software to work within your existing environment and application systems IBM MVS, AS/400, RS/6000, PC (Windows 98, NT, OS/2), UNIX (SUN, DEC, HP, IBM, SCO, etc.), DEC VMS
  • Easy integration into your existing applications
  • License Agreement provides for Toll­Free Technical Support and periodic HCFA updates
  • Ability to handle the entire out­patient population, as well as Medicare cases
  • Customization services and custom interfaces are available

Benefits

  • Ensures accurate APC assignment
  • Accurate and timely HCFA updates
  • Saves development and maintenance costs
  • High Performance ­ effectively analyze single cases or millions of cases
  • Easily integrates to your existing application, on any platform
  • Call as subroutines from your existing programs; easy to use in batch with flexible file interface
  • Unlimited Site License or low­cost Distribution License
  • Unparalleled industry experience and technical expertise via toll­free support line

APC Pricer

APC Pricer, an APC payment and pricing component, provides the flexibility to customize rules and payment rate methodologies for the entire outpatient population. Together, APC Pricer and APC Grouper produce complete, accurate results.