Basic information

The glossary contains the most frequently used terms in the context of the DRG reimbursement mechanism.

Casemix (CM) is the sum of the relative weights of all hospital admissions over a period of time.

Casemix-index (CMI) is the arithmetic mean of the relative weights of all hospitalisation cases over a certain time period and reflects the average economic (cost) intensity of a case over the time period.

The definition guide contains a detailed description of the specific version of the DRG system with a graphical representation of all classification algorithms as well as their associated logical expressions and tables.

DRG (Diagnosis Related Group) is an abbreviation for "diagnosis related group", based on the original English name.

The DRG system is a classification system that allows hospital cases to be classified according to diagnoses, diagnostic and therapeutic procedures into groups with a similar clinical course and similar economic costs.

The effective relative weight is calculated from the catalogue relative weight, taking into account its increase or decrease for admissions outside the defined treatment interval.

The effective casemix and effective casemix-index are calculated from the effective relative weights, i.e. by taking into account decreases or increases in the base catalogue relative weights due to treatment times outside the specified interval or due to transfers between hospitals.

A grouper (gruper) is a software tool (computer program) that ensures that a hospital case is assigned to a specific DRG group.

The main diagnostic category (MDC) represents the first level of classification in the DRG system. It is based on the similarity of cases primarily in terms of organ systems.

The principal diagnosis is the diagnosis that has been determined by analysis to be the main cause leading to the patient's hospitalization.

A hospitalisation case is the admission of a patient to an inpatient healthcare facility (hospital) from the time of admission to hospital until the patient is discharged from hospital.

The case lump sum catalogue is a list of individual DRGs that contains relative weights and other data relevant for DRG billing, such as treatment times and their thresholds for each DRG, reductions and increases in relative weights, and other attributable items, if applicable.

The DRG classification system is an economic-medical classification system in which hospital cases are classified into medically similar and cost-homogeneous groups (DRG groups) on the basis of diagnoses and procedures, as well as some other parameters.

Comorbidity is the simultaneous occurrence of two or more disease processes with no relationship to each other.

A complication is a disease process (or event) that occurs during the course of a disease but is not an essential part of that disease, although it may arise from the disease or have independent causes.

Complications and comorbidities (CC) are secondary diagnoses that generally lead to significantly higher resource consumption.

Coding rules is a methodology for healthcare professionals describing the rules for coding inpatient case diagnoses and procedures.

The case lump sum is a flat amount in euros attributable to a hospital case that is classified in one DRG group according to the DRG system. The case lump sum shall be calculated as the product of the base rate and the effective relative weight, with the addition of other items, if any, according to the catalogue of case lump sums.

The relative weight is an empirically determined value that describes, in relative terms, the average cost per case of a given DRG group. Relative weights are determined based on hospital-specific inpatient case cost data.

The case clinical severity level (PCCL) is a measure of the cumulative effect of comorbidities and complications of a single patient (CCL) calculated for a hospital case. It is a complex calculation designed to prevent the same circumstances from being taken into account multiple times.

The Complications and Comorbidities Severity Level (CCL) is the value that is assigned to all co-morbid diagnoses in the DRG system. CCL values can be 0 to 4 for cases with surgery and for neonates. For other cases, CCL values can be 0 to 3. Values mean: 1=mild CC; 2=moderate CC; 3=severe CC; 4=extremely severe complication or comorbidity.

A secondary diagnosis is a diagnosis that occurs at the same time as the main diagnosis or the illness/difficulties developed during the hospitalisation.

A performance-based payment is financial remuneration to a provider for the total treatment related to a specific hospitalization. This means that the hospital (inpatient health facility) does not receive payment for individual sub-procedures related to treatment or payment for a ward admission, but receives payment for the entire inpatient case that reflects the clinical and economic complexity of comparable cases with an emphasis on efficiency and is not derived from the cost of an individual specific hospital.

The base rate is the amount in absolute value that is reimbursed in the DRG system for an individual case with a relative weight of 1.0. The base rate is determined by calculations based on available financial resources.