A group of people who have been given the same “diagnosis” and who need similar health care; for example, a group of people who have been called “depressed” or a group of people who have been called “sleep-disordered.” These groups are put together by insurance companies to help settle questions about payment.
A system for determining payments to hospitals, used under Medicare's prospective payment system (PPS) and by some other public and private payers. The DRG system classifies patients into groups based on the principal diagnosis, treatments, and other relevant criteria. Hospitals are paid the same for each case classified in the same DRG, regardless of the actual cost of treatment.
Patient classification system that relates demographic, diagnostic, and therapeutic characteristics of patients to length of inpatient stay and amount of resources consumed, that provides a framework for specifying hospital case mix, and that identifies 468 classifications of illnesses and injuries for which Medicare payment is made under the prospective pricing program.