Evolution of Diagnosis Related Groups (DRGs) Module

Prospective payment rates based on Diagnosis Related Groups (DRGs) have been established as the basis of Medicare’s hospital reimbursement system. The DRGs are a patient classification scheme which provides a means of relating the type of patients a hospital treats (i.e., its case mix) to the costs incurred by the hospital. The evolution of the DRGs and their use as the basic unit of payment in Medicare’s hospital reimbursement system represents a recognition of the fundamental role which a hospital’s case mix plays in determining its costs. The development of the DRGs provided the first operational means of defining and measuring a hospital’s case mix complexity.

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Jurisdiction J Module

Jurisdiction M Module