A reimbursement system used by Medicare and other insurers to classify illnesses according to diagnosis and treatment. It clusters patients into 468 categories on the basis of their illnesses, diseases and medical problems. All Medicare inpatient hospital operating costs are determined in advance and paid on a per-case basis, according to fixed amount or weight established for each DRG.
A system of classifying patients on the basis of diagnoses.
A statistical system of classifying any inpatient stay into groups for purposes of payment. This is the form of reimbursement that HCFA uses to pay hospitals for Medicare recipients. Also used by a few states for all payers and by some private health plans for contracting purposes. A standard flat rate per procedure is derived from this scale, which is paid by Medicare for their beneficiaries.
A classification system that groups patients according to diagnosis, type of treatment, age, and other relevant criteria. Under the prospective payment system, hospitals are paid a set fee for treating patients in a single DRG category, regardless of the actual cost of care for the individual.
System of determining reimbursement fees based on the medical diagnosis of a patient.
A payment system for hospital bills. This system categorizes illnesses and medical procedures into groups for which hospitals are paid a fixed amount for each admission.
A way to pay hospitals for health care based on diagnosis, age, gender, and complications.
System that reimburses health care providers fixed amounts for all care given in connection with standard diagnostic categories.
Diagnostic categories used by Medicare (Part A) as case-mix measures, under the prospective hospital payment system. Categories are drawn from the International Classification of Diseases and modified by the presence of a surgical procedure, patient age, comorbidities or complications, and other criteria.