Commission for Case Manager Certification (CCMC) Practice Exam

A Diagnostic Related Group (DRG) represents a type of payment system used to determine reimbursement rates for hospital services based on specific diagnoses. This system was established to standardize payments and control costs in healthcare by grouping patients with similar clinical conditions that require similar levels of care. Each DRG is assigned a relative weight that reflects the average resources used in treating patients within that group. Thus, hospitals are paid a fixed amount based on the DRG assigned to a patient's diagnosis, regardless of the actual cost incurred for their care.

The focus of the DRG system is to encourage efficiency in healthcare delivery, ensuring that hospitals manage their resources effectively while providing necessary care to patients. By linking payment directly to the diagnosis rather than specific services or procedures, it promotes adherence to evidence-based practices and reduces unnecessary variations in treatment.