Certified Inpatient Coding (CIC) Practice Exam

What is the main purpose of the APR-DRG classification system?

1. To apply a flat rate payment for all DRGs

2. To classify patient diagnoses for outpatient payment

3. To provide a comprehensive assessment of healthcare delivery quality

4. To enhance payment accuracy by factoring in severity and risk

The correct answer is: To enhance payment accuracy by factoring in severity and risk

The primary aim of the APR-DRG (All Patient Refined Diagnosis Related Group) classification system is to enhance payment accuracy by incorporating factors such as severity of illness and risk of mortality. This system categorizes patients not only based on their diagnoses but also considers the complexity of their conditions and the resources they are likely to consume during their hospital stay. By refining the diagnosis-related grouping system to take these critical factors into account, the APR-DRG allows healthcare facilities to receive reimbursement that more closely aligns with the actual care provided and the challenges associated with treating patients with more severe health conditions. This results in a more equitable payment model that reflects the distinct levels of care required for patients with varying degrees of illness. In other contexts, varying options typically lack the focus needed for inpatient services. While flat rate payments or outpatient claims may also play roles in the healthcare reimbursement landscape, they don’t capture the complexity and granularity offered by the APR-DRG system.