Selected Bibliography and Glossary on DRG's Prospective Pricing
Keywords:
diagnostic related groups (DRG's), health insurance, hospital reimbursement, prospective paymentAbstract
In 1982, the Tax Equity and Fiscal Responsibility Act modified the Section 223 Medicare Hospital reimbursement limits to include a case mix adjustment based on DRG's. In 1983, Congress amended the Social Security Act to include a national DRGbased hospital prospective payment system for all Medicare patients.
In the view of many physicians and administrators the current formulation of DRG's constitute a workable and clinically coherent set of classifications that relate a hospital's case mix to the resources used and costs incurred by the hospital. DRG's are deline~ted based on principal diagnosis, secondary diagnosis, surgical procedures, age and the discharge status of the patients treated. Through DRG's, hospitals are able to gain an understanding of the patients they treat, the costs incurred and within reason, can anticipate the services required for specific illness.
The classification of DRG's is a constantly evolving process. As coding procedures change, as more comprehensive data is collected, and as medical technology and treatment practices change, DRG's will need to be re-examined and revised.
The following bibliography and glossary of terms highlights several key words and phases which are relevant to the overall discussion of DRG's.
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