diagnosis-related group


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di·ag·no·sis-re·lat·ed group (DRG),

a program in the U.S. for billing for medical and especially hospital services by combining diseases into groups according to the resources needed for care, arranged by diagnostic category. A dollar value is assigned to each group as the basis of payment for all cases in that group, without regard to the actual cost of care or duration of hospitalization of any individual case, as a mechanism to motivate health-care providers to cut costs.

diagnosis-related group

Managed care A prospective payment system used by Medicare and other insurers to classify illnesses according to diagnosis and treatment; DRGs are used to group all charges for hospital inpatient services into a single 'bundle' for payment purposes. See DRGs.

di·ag·no·sis-re·lat·ed group

(DRG) (dī-ăg-nō'sis-rĕ-lā'tĕd grūp)
A classification of patients by diagnosis or surgical procedure (sometimes including age) into major diagnostic categories (each containing specific diseases, disorders, or procedures) for the purpose of determining payment of hospitalization charges, based on the premise that treatment of similar medical diagnoses generates similar costs.

di·ag·no·sis-re·lat·ed group

(DRG) (dī-ăg-nō'sis-rĕ-lā'tĕd grūp)
U.S. billing program for medical and especially hospital services by combining diseases into groups according to the resources needed for care, arranged by diagnostic category.
References in periodicals archive ?
Hospital Lengths of Stay Diagnosis-Related Groups 89, 90 - Pneumonia Hospital B - Syracuse, New York
Nursing dependency, Diagnosis-Related Groups and length of hospital stay.
Heterogeneity of European DRG systems and potentials for a common EuroDRG system: Comment on "Cholecystectomy and Diagnosis-Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries".
Acute Care Length of Stay Distribution Characteristics Diagnosis-related Group 89.90 - Pneumonia Selected Metropolitan Areas
According to the AHA, reviews that are the most difficult to manage and track--RAC complex reviews for medical necessity--will not begin until early 2010; with diagnosis-related group (DRG) and coding reviews late this year.
Currently, the Centers for Medicare and Medicaid Services (CMS) pays hospitals the same amount--about $5,700--under its diagnosis-related group (DRG) payment system for treating a stroke patient, regardless of whether TPA is used.
Using claims filed under the diagnosis-related group for congestive heart failure, Dr.
Table 1 Means and cutoff points for patients within major diagnostic category 15, by diagnosis-related group (DRG) Geometric mean length Outlier DRG of stay (1) cutoff 385 Neonate, died or transferred 3.7 22 386 Neonate, extreme immaturity 17.9 36 387 Prematurity with major problems 13.3 31 388 Prematurity without major problems 8.6 27 389 Full-term neonate with major problems 7.4 25 390 Neonates with other significant problems 4.2 20 391 Normal newborn 3.1 7 (1) Federal Register (1987).
The diagnosis-related group (DRG) system for hospitals and the resource-based relative value scale (RBRVS) for physicians were the new payment methods of the 1980s, but they are being replaced rapidly by capitation and other forms of prepayment (e.g., package prices).
Gertman, P.M., and Lowenstein, S.: A research paradigm for severity of illness: Issues for the diagnosis-related group system.

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