Revenue Cycle: DRG Reimbursement and Case Mix



This course presents a primer on DRGs including the history, grouping logic, common DRG systems, and the role of case mix in the hospital.

Learning Objectives

  • Identify payers who utilize DRG Systems for Reimbursement
  • Recognize the role of a DRG relative weight
  • Detect factors that impact case mix
  • Recognize the impact of surgical procedures on MS-DRG assignment
  • Utilize the DRG Definitions Manual to assign a provisional MS-DRG
  • Identify discharge dispositions that influence MS-DRG reimbursement under the post-acute care transfer provision
  • Identify differences between MS-DRGs and APR-DRGs
  • Recognize uses for severity of illness data
  • Analyze APR-DRG case complexity

Target Audience

  • Inpatient Facility Coders
  • Clinical Documentation Improvement Professionals
  • Revenue integrity professionals
  • Coding compliance managers

CE Credits

This program has been approved for 1 continuing education units for use in fulfilling the continued education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.

This program has the prior approval of the American Academy for Professional Coders (AAPC) for 1 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

Purchasing Details

  • Upon purchase, you will have a 6-month subscription to this course. This will allow you the opportunity to complete and review as often as you like for 6 months.
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