An inpatient or hospital classification system used to pay a hospital or other provider for their services and to categorize illness by diagnosis and treatment. A classification scheme used by Medicare that clusters patients into 468 categories on the basis of patients' illnesses, diseases and medical problems. Groupings of diagnostic categories drawn from the International Classification of Diseases and modified by the presence of a surgical procedure, patient age, presence or absence of significant comorbidities or complications, and other relevant criteria. System involving classification of medical cases and payment to hospitals on the basis of diagnosis. Used under Medicare's prospective payment system to reimburse inpatient hospitals, regardless of the cost to the hospital to provide services.
Health benefit payments to hospitals under Medicare, Part A, are now based upon a prospective payment system that utilizes a predetermined rate per case or type of discharge. Rates are adjusted annually and to reflect regional and wage differences. DRGs are based upon the patient's diagnosis, age and sex, treatment procedure, and discharge status.
A system by which hospital procedures are rated in terms of cost and taking into account the intensity of services delivered. A standard flat rate per procedure is derived from this scale, which is paid by Medicare under the Prospective Payment System (PPS), regardless of the cost to the hospital for providing that service. Back to the top of the page
A method of classifying inpatient hospital services. It is used as a method of determining financing to reimburse various providers for services performed. Disability — An individual's physical or mental inability to perform the major duties of his or her occupation because of an illness or injury. Disability Insurance — A form of health insurance which provides periodic payments when the insured is unable to work as a result of sickness or injury.
The Diagnosis Related Group system classifies patients into groups based on the principal diagnosis, type of surgical procedure, presence or absence of significant co-morbidities or complications, and other relevant criteria. Diagnosis Related Groups are intended to categorise patients into groups that are clinically meaningful and homogeneous with respect to resource use.
A system of classification for inpatient hospital services based on diagnosis, age, sex, and the presence of complications. It is used as a means of identifying costs for providing services associated with a diagnosis and as a mechanism to reimburse hospital and selected other providers for services rendered.
classification of diagnoses for the purpose of hospital reimbursement in the Inpatient Prospective Payment System.
A system used for classification and reimbursement of inpatient hospital services.
The hospital classification and reimbursement system that groups patients by diagnosis, surgical procedures, age, sex and presence of complications. This is a financing mechanism used to reimburse hospital and selected other providers for services rendered.
A patient classification scheme used by Medicare and other insurers that clusters patients into 468 categories on the basis of patients' 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 classification for inpatient hospital services based on principal diagnosis, secondary diagnosis, surgical procedures, age, gender and presence of complications. This system of classification is used as a financing mechanism to reimburse hospital and selected other providers for services rendered, typically based on the average cost of all patients within the DRG. Return to Acronyms
A classification scheme with which to categorize patients according to clinical coherence and expected resource intensity, as indicated by their diagnoses, procedures, age, sex, and disposition, and was established and is revised annually by the U.S. Health Care Financing Administration.