Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:Introduction to Health Care and Public Health in the U.S.
Unit:Financing Health Care - Part 2
Lecture:The Billing Process of Various Health Care Enterprises
Slide content:Diagnosis Related Groups (DRGs) Payments to hospitals for inpatient services for Medicare patients Payments based on: Diagnosis, procedures, age, sex, comorbidities, complications, and discharge status Comorbidity: The presence of 2 or more conditions or diseases in the same patient which complicates a patients hospital stay leading to more resource use or longer length of stay 18
Slide notes:An example of a prospective payment system is the Centers for Medicaid and Medicare Services diagnosis related group system, or DRGs, used for payment to hospitals for inpatient services provided to Medicare patients. Payments are made based upon the age, sex, diagnosis, any existing comorbidities that may affect the length of stay, the number of procedures necessary, expected complications, and discharge status. A comorbidity is the presence of two or more conditions or diseases in the same patient, which complicates the patient's hospital stay, and may lead to more resource use or longer lengths of stay. 18