Diagnosis-Related Group (DRG) reimbursement

DRG reimbursement is a reimbursement system for inpatient charges from facilities. This system assigns payment levels to each DRG based on the average cost of treating all TRICARE beneficiaries in a given DRG. The TRICARE DRG-based payment system is modeled on the Medicare Inpatient Prospective Payment System (IPPS). A grouper program classifies each case into the appropriate DRG.

The grouper used for the TRICARE DRG-based payment system is the same as the Medicare grouper with some modifications, such as neonate DRGs. For more details, see the TRICARE Reimbursement Manual Chapter 6

TRICARE uses the TRICARE Severity DRG payment system, which is modeled on the Medical Severity DRG payment system.

 

DRG calculator

Providers can locate the Indirect Medical Education (IDME) factor (for teaching hospitals only) and wage index information using the wage indexes and IDME factors file that are also available on the DRG webpage. If a hospital is not listed in the wage indexes and POA factors file, use the ZIP to wage index file to obtain the wage index for that area by ZIP Code.

Check out the DRG calculator