If a provider submits one version of DRG and the payer pays based on another version of DRG, which version should be submitted? What if no DRGs are provided at all?


Precedence shall be given to DRGs transmitted from the hospital provider. When the CMS methodology for DRGs is not available, but the All Payer DRG system is available, then that system shall be used. There is a 0 percent threshold required for the associated data element (MC071).