DRG Reporting Frequently Asked Questions



Index of DRG Frequently Asked Questions


Who needs to submit DRG reports?

Reports must be submitted by covered hospitals, workers’ compensation insurers, self-insured employers, and risk management pools.

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Which workers’ compensation claims should I report, i.e. Nebraska only, other states, railroad workers’ compensation?

Report bills subject to the Nebraska Workers’ Compensation Act for Nebraska DRG covered hospitals only.

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Which hospital claims are to be reported?

The only hospital claims that are to be reported are those for hospitals subject to the DRG fee schedule. All workers’ compensation admissions are to be reported whether or not the DRG is in the fee schedule.

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Are all DRGs billed to be reported or just those covered by the DRG fee schedule?

Payors and hospitals are to report all DRGs billed during the reporting period, not just those covered by the DRG fee schedule. If the reported DRG is not included in the fee schedule, there will be no threshold amount for that DRG.

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What dates do I use for reporting purposes, i.e. patient discharge dates, claim submission dates?

Discharge dates.

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What are the dates for the reporting period?

Reports are for the third and fourth quarters of the preceding calendar year and the first and second quarters of the current calendar year.

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Should I report bills that are amended in a later reporting period?

No. Claims are to be counted only once.

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Do I report trauma and contracted claims in the total claim count and in the count of claims exceeding the threshold?

Yes.

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How do I report zero claim information?

Zero claims reports are entered in the court’s web-based data-entry system. Information on zero claim reporting is located in the instructions provided for the DRG reporting system.

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If someone else is reporting for me, how will I know that they have reported successfully?

You will need to check with the entity reporting for you.

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Can I allow my other clients to report under my registration?

Such an arrangement needs to be coordinated among the parties involved. The court does not want duplicate reporting of data.

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