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3M™ Enhanced Ambulatory Patient Grouping (EAPG) System

3M ID B5005024053
  • Simplified analysis and reporting of ambulatory visits
  • Accurately calculates expected payment for ambulatory services
  • Appropriate for all patient populations and payers, not just Medicare beneficiaries
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Specifications
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Risk-based Provider Payment
Organization Type
Billing Services, Business Partner, Government, Health System/Hospital, Payer, Provider
Role Type
Financial, Quality
Product Details
  • Simplified analysis and reporting of ambulatory visits
  • Accurately calculates expected payment for ambulatory services
  • Appropriate for all patient populations and payers, not just Medicare beneficiaries

Ambulatory care may be less complex than inpatient care, but it is no less important to understand patient case mix and resource use in this setting. A better alternative to the CMS APC System, it is appropriate for use with all ambulatory patients, not just Medicare beneficiaries. Unlike CMS APCs, it assigns an EAPG group to every line item, and every payable line item has a payment weight.

The 3M EAPG System classifies outpatient care into patient groups and categories based by key procedures and primary diagnosis code. It consolidates multiple single procedures into a bundle and packages ancillary services together with the significant procedure, where appropriate.

3M EAPGs are a powerful tool for calculating expected payment under an outpatient prospective payment system (OPPS). They also provide a useful metric for benchmarking, analytics, reporting, case management and care coordination.

The 3M EAPG System can be used more broadly than CMS APC Software. It applies to all ambulatory patients, not just Medicare beneficiaries. It also includes all services, including therapies and drugs, received in a range of settings from hospital outpatient departments and ambulatory surgery centers to free standing clinics and renal dialysis centers. The 3M EAPG System is useful in many different workflows:

  • Abstracting and coding to classify outpatient services into patient groups with similar clinical characteristics and expected resource use
  • Billing, patient accounting and denials management to calculate accurate costs and reimbursement
  • Benchmarking, analytics and reporting as a quality measure and to calculate an outpatient case mix index (also called "service mix index")
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