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Diagnosis related groups

You work for the local hospital, and your manager would like some clarification on diagnosis-related groups (DRGs). Discuss Medicare reimbursement in the context of DRGs for reimbursement purposes.

Be sure to address the following:

â?¢use of DRGs in both inpatient and outpatient settings
â?¢an example of a DRG
â?¢the purpose of DRG use in medical coding and billing
â?¢the relationship between DRGs and the ICD-9-CM/ICD-10 coding system

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Solution Preview

* The use of DRG in inpatient settings: Medicare established the inpatient prospective payment system to provide payments to hospitals for the treatment of Medicare beneficiaries in inpatint hospital settings. Under the IPPS system each hospital inpatient stay is assigned to a DRG based on the patient' characteristics and procedures performed during his/her hospital stay. Medicare pays the hospital a prospectively determined amount that is associated with the selected DRG.
The use of DRG's in outptient settings: ...

Solution Summary

This solution provides an explanation of medicare reimbursement in the context of diagnosis related groups (DRG's).