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IGF-1 and its binding proteins were also affected in muscles of ALS patients 22

Commenters indicated that to the extent that a hospital would be required to identify each patient discharge to which a particular rate applied, then determine the MS-DRG that would have applied to that case, and then calculate or determine an MS-DRG rate for that payer based on that claims history, CMS severely understates the hospital burden in completing Worksheet S-12 and that this burden and approach is wholly unsupported

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