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The nurse understands that a diagnostic-related group is one of the reimbursement strategies in a prospective payment system. The diagnostic-related group is a part of which health care system?

a. medicare
b. medicaid
c. capitation
d. Americare

User David Leon
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1 Answer

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Final answer:

The Diagnostic-Related Group is a part of the Medicare (option a) system, which is the public healthcare system offering insurance primarily to people over sixty-five years old. Medicare uses DRGs as part of its prospective payment system to allocate pre-determined reimbursement amounts for patient care, which helps control healthcare spending.

Step-by-step explanation:

The Diagnostic-Related Group (DRG) is a system to classify hospital cases into one of approximately 500 groups, intended to have similar hospital resource use. They have been used in the Medicare program in the United States as a part of its prospective payment system (PPS). Under this system, a predetermined amount of money is allocated for patients' treatment based on their DRG. This is one of the strategies to make hospital spending more efficient and to control costs in the health care system.

Medicare is the public healthcare system that primarily offers insurance to people over sixty-five years old, although others who meet certain eligibility criteria may also be covered. Medicare has two main parts: Part A, which covers hospital charges, and Part B, providing coverage for health-care costs outside of hospital stays like physician services, medical tests, and outpatient visits.

There are other systems such as Medicaid, which is a joint federal and state program that helps cover medical costs for some people with limited income and resources, and does not primarily use DRGs. Capitation is a payment arrangement for health care service providers such as doctors, physicians' groups, and hospitals. They are paid a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care. Americare is not a specific healthcare system or common term used in this context.

User Toomasr
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