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Last Modified: 9/4/2019 Location: FL, PR, USVI Business: Part A

Appeal rights for DRG change recommendation FAQ

Q: Can the hospital appeal the diagnosis-related group (DRG) change recommendation?
A: Yes, for all denied claims the provider has the right to appeal that decision.
Follow the current appeals process as outlined in the Centers for Medicare & Medicaid Services (CMS) internet-only manual (IOM), publication 100-04, Medicare Claims Processing Manual, Chapter 29 -- Appeals of Claims Decisions external pdf file.
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First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.