Question

A nurse is presenting information to a management class of nursing students on the topic of groups of inpatient hospital services that have a fixed reimbursement amount, with adjustments made on the basis of case severity and regional costs. The nurse is presenting information to the class on which topic?

1) Utilization review committee
2) Resource utilization group
3) Capitation payment system
4) Diagnostic-related groups

Answer 1

The nurse is presenting information on Diagnostic-related groups (DRGs), which are used to classify inpatient cases for fixed reimbursement with adjustments for severity and regional costs.

Step-by-step explanation:

The nurse in this scenario is presenting information on Diagnostic-related groups (DRGs). DRGs are a system used in hospitals for the purposes of billing and reimbursement. This system classifies inpatient hospital cases into groups that are expected to have similar hospital resource use.

Payments by Medicare and other payers to hospitals for each case in a particular DRG are fixed, with adjustments made for factors such as case severity and regional costs. This system was designed to contain health care costs and improve efficiency while still maintaining quality of care.