Q:

What is a DRG in health care?

A:

Quick Answer

DRG in health care stands for diagnosis-related groups and is the basis for establishing medical reimbursements. According to the American Academy of Orthopaedic Surgeons, DRGs are an applied theory of industrial management in health care. The basis of DRGs is the concept that health care or care of the patient is a product supplied by the hospital.

 Know More

Full Answer

With a DRG-based system in place for Medicare, the payments for health care are usually made by the government while the providers are hospitals and physicians. Initially the DRG system focused mainly on the Medicare population. Wikipedia emphasizes that this prospective payment system influences physicians and medical staff members by providing a relationship between the similar diagnosis of patients to the hospital costs that are incurred.

The American Academy of Orthopaedic Surgeons reveals that the initial DRG system was limited to just under 500 codes of diagnosis. Care that was given to the patients was analyzed for the resources used for treatment. This system helps the hospitals estimate expenses per patient.

According to Wikipedia, there are several different DRG systems that have been developed in the United States: Medicare DRG (CMS-DRG & MS-DRG); Refined DRGs (R-DRG); All Patient DRGs (AP-DRG); Severity DRGs (S-DRG); All Patient, Severity-Adjusted DRGs (APS-DRG); All Patient Refined DRGs (APR-DRG); and International-Refined DRGs (IR-DRG).

Learn more about Health Insurance

Related Questions

  • Q:

    What are some of the goals of health care reform?

    A:

    In the United States, some of the goals of health care reform are to significantly increase the number of individuals who have access to primary health care, control the growth of health care expenditures and enable individuals with pre-existing conditions to obtain comprehensive health care insurance coverage. The passage of legislation in March 2010, commonly referred to as the Affordable Care Act or the ACA, was an attempt to achieve these goals while also lessening the burden of the increased uncompensated health care costs suffered by hospitals as a result of the recent U.S. economic recession. It is believed that the ACA will help reduce the cost of major health care interventions by enabling more than 30 million previously uninsured individuals to obtain timely primary health care and not delay needed treatment.

    Full Answer >
    Filed Under:
  • Q:

    When do you get a Medicare provider number?

    A:

    Doctors and other health care professionals receive a Medicare provider number after approval of the online application referred to as the Provider Enrollment, Chain and Ownership System, known as PECOS, or the paper enrollment process, CMS-855, says Centers for Medicare & Medicaid Services. PECOS provides additional benefits after approval.

    Full Answer >
    Filed Under:
  • Q:

    What is affordable health insurance?

    A:

    The Affordable Care Act defines a health care plan as affordable if the total costs of the plan do not exceed 9.5 percent of an employee's income each year, according to the Society for Human Resource Management. These plans may be defined using three methods established by the IRS.

    Full Answer >
    Filed Under:
  • Q:

    What is dental insurance?

    A:

    Dental insurance is financial coverage for preventative and treatment-based dental health care. A person pays a dental health insurance provider premiums in exchange for guaranteed payments of benefits on covered services. Many people participate in group-based PPO or HMO provider network plans.

    Full Answer >
    Filed Under:

Explore