What is the Purpose of DRG?

When it comes to medical terminology and classification systems, there is a lot to know. In fact, it can be very confusing sometimes to know the definitions and purposes of each term or classification. One such term that can sometimes be misunderstood is that of Diagnosis Related Group (DRG).

What is a Diagnosis Related Group?

A diagnosis related group, or DRG, is a classification system used in the healthcare industry that helps hospitals to standardize patient payments and also initiate cost containment for procedures. Hospitals will usually utilize a DRG auditor and invest in DRG auditor training to help them minimize outpatient overpayments and reduce the potential for any claims.

Typically, DRG payments include nearly all of the potential payments that would be associated with their inpatient stay. This includes the time from admission to the time of discharge. It also includes any of the services that would have been provided by any outside provider. Once a patient has been discharged, the claims for the inpatient stay are then processed for payment.

How are DRG Assignments Made?

Patients are categorized in the DRG based on a few variables:

  • Sex and age of patient
  • The discharge status
  • The principal diagnosis
  • Any secondary diagnosis
  • Procedures that were done
  • Any complications that came up

There are also a few other terms to be aware of when dealing with a DRG. For instance, when it comes to DRG payment there can be what are considered outliers. Outliers are the patients that have an unusually high cost compared to the typical patient with the same DRG classification. Depending on the hospital, there may be different ways for dealing with payment calculations in regards to outlier situations.

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There are also what are considered groupers. A grouper is any software or program that has been specifically designed to help with the DRG classification.