What Are DRG and Trim Points?
Diagnosis Related Groups
- Diagnosis related groups are groups of patients with similar clinical characteristics and costs. Factors such as diagnosis, age, surgical procedures and other health-related issues determine a patient's DRG assignment. Insurance providers, including Medicare, establish payment plans based off the average for all patients within a DRG. Hospital bills include DRG information to allow insurance providers to decide their portions of the payment based on the average cost of patients with similar characteristics. The patient receives the remainder of the bill.