CPB Certified Professional Biller Certification Practice Exam

What is the main goal of the All Patient Refined Diagnosis-Related Group system?

1. To decrease hospital funding

2. To standardize outpatient billing

3. To adjust Medicare reimbursement rates based on patient illness severity

4. To eliminate billing for non-Medicare services

The correct answer is: To adjust Medicare reimbursement rates based on patient illness severity

The primary goal of the All Patient Refined Diagnosis-Related Group (APR-DRG) system is to adjust Medicare reimbursement rates based on the severity of patient illness. This system categorizes patients according to their clinical conditions and the intensity of the resources required for their care, allowing for more accurate reimbursement that reflects the complexity and severity of the illnesses treated. By using this approach, the APR-DRG system aims to ensure that hospitals receive fair compensation for the care they provide, particularly for patients with more severe conditions that may require additional resources and longer stays. In contrast, the other options do not accurately reflect the purpose of the APR-DRG system. The reduction of hospital funding, for instance, is not a goal but rather a potential byproduct of cost-control measures in healthcare. Standardizing outpatient billing would focus on outpatient services specifically, rather than the inpatient focus of the APR-DRG. Lastly, while the system is relevant to Medicare services, eliminating billing for non-Medicare services is not an objective of the APR-DRG; instead, it centers around improving the accuracy of reimbursement for Medicare patients based on clinical needs.