CPB Certified Professional Biller Certification Practice Exam

What do DRGs generally evaluate to determine hospital reimbursement?

1. Patient satisfaction ratings

2. Intensity of resources used for patient care

3. The total length of hospital stay

4. Outcomes of the surgical procedures

The correct answer is: Intensity of resources used for patient care

The correct answer focuses on the intensity of resources used for patient care, which is fundamental to the Diagnosis-Related Groups (DRGs) system. DRGs categorize hospitalization costs and determine how much to pay for a patient’s hospital stay based on the diagnosis. This payment model aims to encapsulate the complexity and cost associated with different types of care provided, including the resources utilized during treatment. In contrast, while patient satisfaction ratings, length of stay, and surgical outcomes are important metrics in healthcare, they do not directly influence the DRG methodology, which primarily evaluates resource consumption relating to diagnoses and associated treatments for reimbursement purposes. Therefore, the emphasis on resource intensity aligns perfectly with the objectives of DRGs and their role in hospital reimbursement systems.