Question

Insurance and billing are an important part of the health managers’ job: Be prepared to define & discuss DRGs, CPTs, etc.   

DRG - Diagnostic Related Group

CPT - Current Procedural Terminology  

COURSE:  Information Technology for the Health Professions   

Answer 1

DRG:

Its Diagnostic Related Groups

DRG is a statistical system of classifying any inpatient stay into the group for the purpose of payment.

Purpose:

1. This system divides the possible diagnosis into more than 20 major body system.

2. And sub divides then into 500 groups for the purpose of medical reimbursement.

Components:

1. ICD 10 coding

2. Cost of treatment

MS- DRG: Medicare Severity Diagnostic Related Groups.

CPT:

Current Procedural Terminology:

Cpt is a medical code set that is used to report medical, surgical, diagnostic procedure and services to entities such as physician, health insurance company and accredited organization.

Purpose:

1. Uniform language to describe medical, surgical and diagnostic test.

2. It helps in medical care review.

Categories:

Category 1:

Procedure with contemporary medical practice.

Category 2:

Supplementary tracking code for performance measure.

Category 3:

Temporary code for emerging measures.