Diagnostic-related groupings (DRG) creep occurs when staff members manipulate codes to increase reimbursement.

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Prepare for the Coach CFE Exam. Study using flashcards and multiple-choice questions, each with hints and explanations. Get ready for your assessment!

Multiple Choice

Diagnostic-related groupings (DRG) creep occurs when staff members manipulate codes to increase reimbursement.

Explanation:
In DRG-based payment, the assigned DRG determines how much a hospital gets for a stay. When staff intentionally codes a patient to a higher-severity or more complex DRG to boost reimbursement, that practice is DRG creep. It relies on the incentive built into the system: more severe or bundled diagnoses and procedures can yield higher payments. Legitimate coding should reflect the true condition and services, not inflate them. Therefore, the statement is true: DRG creep occurs when codes are manipulated to increase reimbursement.

In DRG-based payment, the assigned DRG determines how much a hospital gets for a stay. When staff intentionally codes a patient to a higher-severity or more complex DRG to boost reimbursement, that practice is DRG creep. It relies on the incentive built into the system: more severe or bundled diagnoses and procedures can yield higher payments. Legitimate coding should reflect the true condition and services, not inflate them. Therefore, the statement is true: DRG creep occurs when codes are manipulated to increase reimbursement.

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