Diagnosis Related Group {DRG} Meaning

DRG is a system to classify hospital cases into one of Approximately 500 groups, also referred to as DRG'S expected to have similar hospital resource use. They have used in US since 1983. There is more than one DRG system being used in the United States, but only the MS-DRG system is used by Medicare. 

tags  :
diagnosis code meaning,

Insurance Types:{medical billing}

ü Federal Insurance

ü Private Insurance

ü Liability Insurance

Federal Insurance:

1. Medicare

  * Part A (Hospital Insurance)

  * Part B (Supplementary Medical Insurance)

  * Part C (Medicare + Choice)

  * Part D ( Prescription Drug)

2. Medicaid

3. CHAMPUS (Civilian Health And Medical Program for Uniform Services)

4. CHAMPVA (Civilian Health And Medical Program of Department of Veteran Services)

Private Insurance:

1.Medigap

2.IHP

3.GHP

Liability Insurance:

   * General Liability ( fire, house owner’s Risk, etc.,)

  * Auto Insurance

  * Workers Compensation Liability

Concepts of Insurance Company (Medical Billing)

1.  Traditional

  i. Basic Coverage  (In-patient service)

  Its covered technical components

  ii. Major Medical Plan (Out-patient service)

  Its covered professional component

  iii. Comprehensive Coverage (both In & Out patient service)

2.  Managed Care

HMO (Health Maintenance Organization)

POS (Point of Service)

PPO (Preferred  Provider Organization)

EPO (Exclusive Provider Organization)