drgsystem

DRGSystem is a software platform intended to support the classification and billing workflows associated with Diagnosis-Related Groups (DRGs) in healthcare settings. It provides a rule-based engine to assign DRGs from patient encounters and procedures, and it aggregates classification results and related metadata for reimbursement, reporting, and audit purposes.

Core features include DRG classification and coding mapping, data import and export from common electronic health record and billing systems, support for payer-specific rules and policies, audit trails for changes, and compliance with coding standards. The platform emphasizes interoperability, offering APIs and interfaces such as HL7 and FHIR to integrate with existing health IT infrastructure. It also supports locale-specific DRG dictionaries for different countries.

Architecture and data model: DRGSystem is designed modularly, with components for the classification engine, data integration layer, rule management, and reporting module. It supports versioned DRG dictionaries, audit logging, and extensible configuration to accommodate updates in coding conventions. The data model centers on patient encounters, diagnoses (ICD codes), procedures (CPT/HCPCS), admission and discharge details, and payer information.

Development and impact: The project originated from collaboration among healthcare IT professionals and vendors seeking to streamline DRG-based reimbursement. It is used by hospitals, ambulatory facilities, and payer organizations to automate DRG assignment, improve billing accuracy, and produce operational and quality reports. Availability and licensing vary by distribution, with options ranging from commercial deployments to community-supported releases.

See also: Diagnosis-related group; Healthcare information technology; Revenue cycle management.