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PubMed · 10382495

Nurses' basic guide to understanding the Medicare PPS.

M T Knapp
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Abstract

Nurse leaders grappling with changing reimbursement need to know the background and structure of Medicare's Prospective Payment System. The author explains case mix and Resource Utilization Groups, as well as applications for practice.

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Diagnosis-Related GroupsHumansMedicareNursing, SupervisoryProspective Payment SystemUnited StatesJournal Article

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BibTeXRIS

M T Knapp. 1999. Nurses' basic guide to understanding the Medicare PPS.. https://pubmed.ncbi.nlm.nih.gov/10382495/

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PubMed2002

[Measuring case severity with a DRG-based reimbursement system].

BACKGROUND: The Australian Refined Diagnosis-Related Groups (AR-DRGs) will be the model for the German DRGs (G-DRGs). Their system to measure severity of illness will be a major point of interest. METHOD: The most common systems for measuring severity of illness are presented and compared with the AR-DRGs based on criteria regarding applicability. RESULTS: None of the systems for measuring severity of illness fits all the criteria. They can be used for reimbursement of inpatient care or for quality assurance, but not for both at the same time. The designated areas for the use of the systems should not be exceeded. CONCLUSION: AR-DRGs are very complex in measuring the costs per case (severity of illness in terms of efficiency). They are not able to support quality assessment by risk adjustment (severity of illness in terms of medical complexity). A less complex system would have been easier to transfer to Germany with the same incentives for providing effective care.

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