Certified Revenue Cycle Representative (CRCR) Practice Exam

What is included in each Diagnosis-Related Group (DRG)?

1. A list of outpatient procedures

2. A relative weight for reimbursement calculation

3. The average length of stay for each diagnosis

4. A fixed price for services provided

The correct answer is: A relative weight for reimbursement calculation

The inclusion of a relative weight for reimbursement calculation within each Diagnosis-Related Group (DRG) is fundamental to the functionality of DRGs in healthcare reimbursement systems. Each DRG is associated with a relative weight that reflects the resource intensity required for the treatment of patients with specific diagnoses. This weight is crucial as it allows for the calculation of payment amounts to healthcare providers under prospective payment systems, such as Medicare. For instance, higher relative weights are assigned to more complex cases that necessitate more resources, while simpler cases receive lower weights. This system ensures that hospitals are compensated fairly based on the expected costs associated with treating different conditions, encouraging efficiency and cost management within the healthcare system. In contrast, the other options do not accurately define what is included within a DRG. A list of outpatient procedures is not pertinent as DRGs primarily apply to inpatient stays. The average length of stay can be a component of the data collected for DRG purposes, but it is not a definitive inclusion of what comprises a DRG itself. A fixed price for services may stem from the payment calculation based on the relative weight, but the value itself is not directly part of the DRG; rather, it is derived from the relative weight assigned.