A diagnosis-related group (DRG) is a tool implemented to categorize patients with similar clinical diagnoses. The tool determines payer reimbursement rates. This will result in better control of hospital costs. DRGs are assigned by a "grouper" program which gathers claim information based on ICD diagnoses, procedures, age, gender, discharge status and the presence of complications or comorbidities. All these factors are used to determine the appropriate DRG on a case-by-case basis.
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Category: Data and AI
Sector: Government, Private
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