The new DRG is a mixed payment method in which the NHIS pays for medical expenses incurred during a single medical treatment, dividing the cost of procedures, drugs, and therapeutic materials into all-inclusive and non-inclusive fees.
Most medical services are comprehensively bundled together, but high-value services that cause differences in medical expenses are paid indelendently. In this report, we have selected the most important aspects of this new system in regard to therapeutic mateirlas.
Table of Contents
Abbreviations and AcronymsDisclaimer
Preface
Executive Summary
1 Payment Systems of National Health Insurance Service
1.1 FFS (Fee-For-Service)
1.2 DRG (Diagnosis Related Group)
1.3 Fixed Pricing
1.4 New DRG (Diagnosis Related Group)
1.5 DRG vs. New DRG
2 Background on Introduction of New DRG
2.1 New DRG Expansion History
2.2 Medical Billing Formula for New DRG
3 New DRG Management
3.1 New DRG Applications
3.2 New DRG Classification Criteria
3.3 Inclusive & Non-Inclusive Products of New DRG
3.4 Issues with New DRG Criteria Change
4 Actual Cases of New DRG Inclusive Product Changes
4.1 Anti-Adhesion Products
4.2 Disposable Shears (Electric/Ultrasonic)
4.3 Circular Staplers
4.4 Intraocular Lens
- Appendix 1 History of NHIS Payment System
- Appendix 2 Categorizing New Reimbursement Items as Non-Inclusive or Fully Non-Inclusive Exceptions
Methodology
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