A client undergoes a knee replacement surgery and is included in the diagnostic-related group (DRG) 209 . Which of the following is true about knee replacement surgery under the DRG system?
A) Replacement and surgeries are not reimbursed.
B) Replacement and surgeries are reimbursed at a predetermined rate.
C) Replacement and surgeries are reimbursed after 1 year.
D) Replacement and surgeries are not insured.
B
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If a group of diseases falls in the same diagnosis-related group category, it means that all the procedures are reimbursed at basically the same rate. If actual costs are less than the reimbursed amount, the hospital keeps the difference. If costs exceed the reimbursed amount, the hospital is left with the deficit. In a DRG system, the procedures and surgeries are grouped together and the reimbursements are done at flat rate within a group. The replacement and the surgeries are reimbursed after an appropriate time and not after 1 year. Also, the replacement and the surgeries are insured.
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