DRG Coding QIO Procedural Transmittal Hospital Request for Higher Weighted DRG If there is a coding error, hospitals can resubmit a claim. They must do so within 60 days of receiving the payment from the fiscal intermediary. If the new DRG is lower or higher weighted than the original, the hospital should ask for an adjustment. A hospital can do that by submitting an adjustment request to the fiscal intermediary.
If Quality Insights finds a quality concern in the course of the DRG or utilization review, we will take action.
If the hospital disagrees with the higher weighted DRG or an admission denial, Quality Insights will follow the DRG Validation Process and the Utilization Review Process to address a disagreement with the higher weighted DRG.
After the fiscal intermediary processes the adjustment, CMS will ask Quality Insights to review the claims that are assigned a higher weighted DRG.