The standard rate for a weighted DRG reimbursement calculation is stored in a fee schedule.

• A. False
• B. Not sure
• C. It depends
• D. True

Answer: (A)

The payment for inpatient stays under the DRG system is determined by DRG weights times a base rate, not by a fee schedule. Each admission is assigned to a DRG, and that DRG has a weight that reflects the relative resources typically required. The fixed base rate (set nationally and adjusted for factors like location or teaching status) is multiplied by that DRG weight to produce the payment per admission, with possible additional adjustments for outliers. A fee schedule, on the other hand, lists allowable amounts for individual, billable services (such as physician or outpatient procedures) rather than the bundled per-admission DRG payment. So the statement is false because the standard DRG reimbursement rate isn’t stored in a fee schedule. For example, a DRG with weight 2.0 and a base rate of $5,000 would yield about $10,000 before any adjustments.