Under Medicare DRG pricing, who pays the extra $40?

• A. The agency that took the x-ray
• B. The patient
• C. The government
• D. The hospital

Answer: (A)

Medicare uses a fixed, per-discharge payment to hospitals based on the DRG. That amount covers most routine inpatient care, but services outside what the DRG payment covers are billed separately by the provider who performed them. In this case, the x-ray was done by an outside radiology agency, so that agency would bill for its service separately. The extra charge isn’t absorbed by the hospital within the DRG payment, nor is it typically charged to the patient as part of the DRG rate; instead, the radiology provider collects that additional amount.