Last Modified: 12/7/2018 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 .
Source: CMS IOM Pub. 100-04, Chapter 29
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