The Optum DRG Grouper Calculator Add-on is a simple, web-based tool designed for acute care facilities to accurately group diagnosis and procedure codes into the correct MS-DRG based on dates of service. It is an add-on module that requires a separate subscription to a qualifying Optum online coding application, such as RevenueCyclePro.com.
This tool provides claim-level, hospital-specific reimbursement calculations, including outlier payments, allowing users to identify potential errors or opportunities for additional reimbursement. The underlying technology leverages industry-leading grouping logic from Optum Enterprise Computer Assisted Coding (CAC) and reimbursement calculations from Optum EasyGroup Rate Manager.
Key Features and Capabilities:
- MS-DRG Grouping: Groups at the claim level, providing results including MDC (Major Diagnostic Category), DRG, DRG description, and identification of CC/MCC (Complication or Comorbidity/Major Complication or Comorbidity) diagnosis codes.
- Reimbursement Calculations: Provides detailed, hospital-specific claim-level reimbursement results, including outlier payments, which are displayed on-screen and in printable formats.
- Code Comparison: Allows users to enter more than one code scenario at a time and compare the results side-by-side.
- Provider Lookup: An easy-to-use tool to quickly find any acute care hospital by provider number or hospital name.
- Integrated Content: Seamlessly integrates with the comprehensive reference content within RevenueCyclePro.com to research elements that affect the DRG, such as CC/MCC, procedure by proxy, optimizing tips, and DRG crosswalks.
The Optum DRG Grouper is primarily used by medical coders, clinical documentation improvement (CDI) specialists, and revenue cycle professionals in facility markets to ensure coding accuracy and maximize appropriate reimbursement.