A diagnosis-related group (DRG) is a case-mix complexity system implemented to categorize patients with similar clinical diagnoses in order to better control hospital costs and determine payor reimbursement rates. For example, Medicare pays out a set amount based on a patient’s DRG as opposed to reimbursing the hospital for its total costs. This method encourages the hospital to minimize care costs.
What is a DRG example?
Examples of some of the most common DRGs tracked at U.S. hospitals include:
- Sepsis, or septicemia
- Heart failure and shock
- Respiratory infections and inflammations