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Question 2: The Oriole MCO uses a typical diagnosis-related groups (DRGs) payment method to reimbursethe Isle Hospital for its treatment of Oriole members. Under the DRG payment method, whenever an
Oriole member is hospitalized at Isle, Oriole pays Isle
A. an amount based on the weighted value of each medical procedure or service that Isle provides,
and the weighted value is determined by the appropriate current procedural terminology (CPT) code
for the procedure or service
B. a fixed rate based on average expected use of hospital resources in a given geographical area for
that DRG
C. a retrospective reimbursement based on the actual costs of the Oriole member's hospitalization
D. a specific negotiated amount for each day the Oriole member is hospitalized
Correct Answer: B
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