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In response to comments that a hospital would be required to (1) identify each patient discharge to which a particular rate applied, then (2) determine the MS-DRG that would have applied to that case, and then (3) calculate or determine an MS-DRG rate for that payer based on that claims history, we agree with the first two statements, but is it unclear what the commenters mean by the third statement with respect to the claims history

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For certain hospitals, under the regulations at 42 CFR 419.43(d)(5)(iii), we use the statewide average default CCRs to determine the payments mentioned earlier if it is not possible to determine an accurate CCR for a hospital in certain circumstances