HI 215 PUG Performance Improvement & Diagnosis Related Group Discussion


HI215: Reinbursement Methodologies

Topic #1: DRGs

Most of the people involved with coding and billing are at least familiar with today? diagnosis-related group (DRG) system for paying inpatient hospital admissions. Medicare made a dramatic change in 1983 in how it handled hospital payments for its members.


Review the PDF from CMS (Centers for Medicare and Medicaid Services) on Acute PPS system from the reading this unit.

  • What is a DRG? What is difference between a DRG and a MS-DRG?
  • How are DRGs or MS-DRGs developed and calculated? What are the components of each?
  • What are the pros and cons associated with the DRG system?
  • How can the DRG affect the hospitals business plan for future growth? Think about how this information would serve you in planning as a manager of a billing department.

HI230: Quality Assurance and Statistics in Health Information

Topic #2: Performance Improvement
Why are accreditation and certification important for the health care facility? In your response explain the performance improvement perspectives of accreditation and certification of the organizations. Be sure to justify your position. Also, share what the requirements are for your state (Mississippi).

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