DRG Payment Variance (REM)

DRG Payment Variance (REM) compares reimbursement rates for ICD-10 claims for the given payer and DRG.

Business Use

Identify where reimbursement variance is occurring in ICD-10 DRG based payments.

Running the Report

To generate the DRG Payment Variance (REM) report:

  1. Click Run on the DRG Payment Variance (REM) report pod.
  2. Use the calendar function to enter a Payment Begin Date.
  3. Use the calendar function to enter a Payment End Date.
  4. Select one or more CIDs from the values displayed.
  5. Select the option of whether or not to include test claims.
  6. Click Run Query.

Tab Views and Field Descriptions

See the following pages for details on these tabs:

This tab shows reimbursements averages by Payer and DRG for claims.

Column Description
Payer Payer associated with claim.
DRG on Claim DRG code from claim.
DRG on Payment DRG code from remit service info.
Different DRGs Identifies if the DRG on the claim is the same DRG found on the payment.
Code Type Identifies the claim as ICD-10.
Average Payment Amount Total claim payment divided by total number of payments.
Average Patient Responsibility Total patient responsibility divided by total number of payments.
Average Reimbursement Total of claim payment plus patient responsibility divided by the total number of payments.
Total Number of Payments Total number of payments.

This tab shows each PCN reimbursement for the Payer and DRG.

Column Description
Payer Payer associated with claim.
DRG on Claim DRG code from claim.
DRG on Payment DRG code from remit service info.
Different DRGs Identifies if the DRG on the claim is the same DRG found on the payment.
Code Type Identifies the claim as ICD-10.
Patient Control Nbr Patient control number.
Payer Payment Amount Total claim payment.
Patient Amount Patient responsibility.
Reimburs. Amount Total claim payment plus patient responsibility.
Avg Reimburse. for Payer/DRG Total of claim payment plus patient responsibility divided by the total number of payments.
Reimburs. Difference Total reimbursement amount minus average reimbursement.
% Variance Reimbursement variance from average reimbursement.
LOS Length of stay.
Discharge Status Discharge code and status detail.