What factors influence DRG assignment and reimbursement?
Also question is, what directly influences the assignment of DRGs?
One MS-DRG is assigned to each inpatient stay. The MS-DRGs are assigned using the principal diagnosis and additional diagnoses, the principal procedure and additional procedures, sex and discharge status. Diagnoses and procedures assigned by using ICD-9-CM codes determine the MS-DRG assignment.
Secondly, how has DRG changed hospital reimbursement? A diagnosis-related group (DRG) is a patient classification system that standardizes prospective payment to hospitals and encourages cost containment initiatives. In general, a DRG payment covers all charges associated with an inpatient stay from the time of admission to discharge.
Beside this, what affects DRG assignment?
When an OR procedure is performed, a surgical DRG is assigned. CCs and MCCs are secondary diagnoses that may impact the DRG assignment (see examples in Table). In most cases, a CC increases the relative weight and an MCC results in an even higher weight that impacts severity and reimbursement.
How is DRG reimbursement calculated?
Calculating DRG payments involves a formula that accounts for the adjustments discussed in the previous section. The DRG weight is multiplied by a “standardized amount,” a figure representing the average price per case for all Medicare cases during the year.