Under the prospective payment system, inpatient reimbursement is based on relative weight times which factor?

Under the prospective payment system, inpatient reimbursement is based on relative weight times which factor?

• A. GMLOS
• B. Hospital Charges
• C. Hospital Payment Rate
• D. AMLOS

Answer: (C)

In the prospective payment system, inpatient reimbursement is determined by multiplying a DRG’s relative weight by the hospital payment rate (the conversion factor). The relative weight reflects how resource-intensive a DRG is, and the hospital payment rate converts that weight into a dollar amount. Adjustments like wage index, teaching status, and outlier payments may modify that base rate, but the fundamental multiplication is weight × payment rate. Length-of-stay measures (GMLOS, AMLOS) and hospital charges aren’t used to set the base PPS payment.

In the prospective payment system, inpatient reimbursement is determined by multiplying a DRG’s relative weight by the hospital payment rate (the conversion factor). The relative weight reflects how resource-intensive a DRG is, and the hospital payment rate converts that weight into a dollar amount. Adjustments like wage index, teaching status, and outlier payments may modify that base rate, but the fundamental multiplication is weight × payment rate. Length-of-stay measures (GMLOS, AMLOS) and hospital charges aren’t used to set the base PPS payment.