Question

An elderly patient with pneumonia is in an acute care hospital. Medicare will pay for 4 days of care in the facility. What prospective payment system is responsible for determining this reimbursement?

a. Evaluation of nursing documentation
b. Submission of appropriate physician progress notes
c. Clinical (critical) pathways
d. Diagnosis-related groups (DRGs)

Answer 1

Diagnosis-related groups (DRGs) are the prospective payment system that determines Medicare reimbursement for an elderly patient's hospital care.

Step-by-step explanation:

The prospective payment system responsible for determining the reimbursement for a Medicare patient's care in an acute care hospital is the Diagnosis-related groups (DRGs). Medicare Part A operates on this system and classifies patients into different groups based on their diagnoses, the procedures they undergo, age, sex, and discharge status. Hospitals are then paid a fixed rate for the entire hospital stay of a patient within each DRG. This predetermined rate is meant to cover all charges associated with an inpatient stay, from bed and board to tests, drugs, and surgeries.