DRG payments are determined by which variables?

• A. Principal diagnosis; Secondary diagnosis(es); Surgical procedures performed; Comorbidities and complications; Patient's age and sex; Discharge status
• B. Insurance coverage, physician preference, hospital size, patient satisfaction
• C. Length of stay, patient’s age, sex, and diagnosis
• D. Discharge status only

Answer: (A)

DRG payments are determined by assigning the hospitalization to a DRG that reflects the expected resources used. This assignment is driven by the patient's principal diagnosis and any secondary diagnoses, the surgical procedures performed, and whether there are comorbidities or complications. The patient’s age and sex, along with discharge status, are also used to fine-tune the DRG and its payment weight. Together, these factors place the case into a DRG with a specific payment amount. Non-medical factors such as insurance coverage or hospital size do not set the DRG payment, and length of stay or discharge status alone do not determine it.