A primer for understanding diagnosis-related groups and inpatient hospital reimbursement with nursing implications.
This study describes diagnosis-related groups (DRGs) as set forth by the Centers for Medicare and Medicaid (CMS). Factors that impact a DRGs length of stay and reimbursement, including the case mix index, blended rates, and medical coding guidelines, are discussed. Nurses can play roles that greatly impact the final DRG for each inpatient medical record.
Beaty
Laura
L
Memorial Hermann Southwest Hospital, Houston, TX 77074, USA.
D019090:Case Management; D014487:Centers for Medicare and Medicaid Services, U.S.; D003953:Diagnosis-Related Groups / Q000191:economics; D004282:Documentation; D017722:Hospital Charges; D006801:Humans; D008484:Medicaid / Q000191:economics*; D006278:Medicare / Q000191:economics*; D024802:Nurse's Role; D009738:Nursing Service, Hospital / Q000191:economics*; D011445:Prospective Payment System; D013041:Specialties, Nursing; D014481:United States