A primer for understanding diagnosis-related groups and inpatient hospital reimbursement with nursing implications

Abstract

This study describes diagnosis-related groups (DRGs) as set forth by the Centers for Medicare and Medicaid (CMS). Factors that impact a DRGs length of stay and reimbursement, including the case mix index, blended rates, and medical coding guidelines, are discussed. Nurses can play roles that greatly impact the final DRG for each inpatient medical record.