Which reimbursement method is typically associated with inpatient hospital stays?

• A. DRG-based reimbursement
• B. Per diem reimbursement
• C. Per-visit billing with CPT
• D. Capitation

Answer: (A)

Inpatient hospital reimbursement is typically handled through a diagnosis-related group (DRG) system. Each hospitalization is categorized into a DRG based on the principal diagnosis, procedures, patient characteristics, and any complications or comorbidities. The hospital is paid a fixed amount for the admission regardless of the exact services or length of stay, which is a prospective payment method aimed at standardizing costs and encouraging efficiency.

Per diem would bill by day, leading to variable totals based on length of stay. Per-visit billing with CPT is an outpatient approach for encounters, not inpatient stays. Capitation pays a set amount per patient per period under managed care and isn’t the standard method for inpatient admissions.