A case that cannot be assigned an appropriate DRG because of an atypical situation is called a(n):

Question

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A case that cannot be assigned an appropriate DRG due to atypical situation is called a cost outlier. This means that the case falls outside the range of typical costs for the assigned DRG, and additional payment may be required to cover the higher costs. A misdiagnosis would not be the correct term in this situation, and neither would cost differential or unsubstantiated claim.

A Case That Cannot Be Assigned an Appropriate DRG Because