Final answer:
The pre-established Medicare reimbursement system for patients before services are provided is the Diagnosis-Related Group (DRG) system. It aims to standardize payments and promote efficiency, reducing the risk of adverse selection in the healthcare insurance market.
Step-by-step explanation:
The question relates to the system by which reimbursements for Medicare patients are determined before services are provided. Among the options provided, the correct answer is B. DRG, which stands for Diagnosis-Related Group. This system classifies hospital cases into groups that are expected to have similar hospital resource use, thus establishing a predetermined level of reimbursement.
Under this system, healthcare providers are reimbursed for services based on fixed, predetermined rates for each DRG, which theoretically incentivizes efficiency in service delivery. Unlike fee-for-service systems where the cost of services is directly reimbursed, DRG focuses on the type of diagnosis and related procedures, potentially reducing the risk of adverse selection where patients with known high risks would otherwise lead to higher insurance costs.
Medicare Part B, mentioned separately, is a program that provides coverage for physician services and outpatient visits, contrasting with inpatient hospital stay reimbursements. Understanding these various healthcare payment models is crucial for navigating and administering care within the US healthcare system.