American Academy of Professional Coders (AAPC) Practice Exam

How do MS-DRGs affect hospitals?

1. They determine patient treatment methods

2. They dictate the length of hospital stays

3. They determine the reimbursement amounts from Medicare

4. They manage hospital staffing needs

The correct answer is: They determine the reimbursement amounts from Medicare

The correct answer highlights that MS-DRGs, which stand for Medicare Severity Diagnosis Related Groups, primarily function to determine the reimbursement amounts from Medicare. This system categorizes hospital cases into groups that are expected to have similar hospital resource use. Each group corresponds to a predetermined payment level set by Medicare. Hospitals are paid a fixed amount based on the patient's assigned MS-DRG, regardless of the actual cost incurred for the patient's care. This incentivizes hospitals to operate more efficiently and control costs, as they will not receive additional compensation for extended stays or excessive treatment costs beyond the set amount for the assigned group. Understanding this mechanism is crucial for hospital administrators and coders, as it directly impacts hospital revenue and financial planning. The other options, while related to patient care and hospital operations, do not accurately represent the specific function of MS-DRGs in the context of reimbursement methodologies within the Medicare system.