Saudi Arabia moves admitted private-insurance care to DRG payment in 2028. Each hospital's price will be negotiated on the case mix it proves in 2026 and 2027, so the coding done now sets revenue after the switch.

A reader expects the regulator to publish a price per case. CHI does publish a benchmark, the Market Reference Price, built from NPHIES claims data as a base price times each DRG's relative weight, and the guideline says twice that it does not constitute a mandated tariff.

Each hospital negotiates its own base rate with each payer, and the guideline lists what may move it above or below the reference: hospital size and service mix, quality indicators, location and operating cost, length of stay and readmissions, case mix, network strategy and volume commitments. Section 7.4 says CHI publishes the full relative-weight table on its website.

When we checked CHI's Clinical Classification Standards page on 30 September 2026, it linked the guideline, a DRG white paper and a diagnostic-packages note, and neither a weight table nor a reference price value.

During 2026 and 2027 every admitted claim sent through NPHIES carries two things: the fee-for-service claim that pays, and a DRG code produced by a CHI-certified grouper that does not. CHI extracts the case mix index, the error-DRG rate and the variance between DRG and fee-for-service payment from that data, and payers are told to use the same comparison to prepare for contracting.

The guideline tells providers to use their shadow-billing case mix index to demonstrate the complexity of their patients. It also says what happens when documentation is thin: the episode is under-assigned to a lower-complexity DRG and paid less than is clinically appropriate. On our reading, a hospital that codes poorly through 2027 walks into its 2028 base-rate negotiation with a case mix that understates its patients, and the payer holds the same data.

Section 4.2.3 caps error DRGs at 3% of submitted episodes in any reporting month, and a provider over that line for two consecutive months must run a mandatory improvement plan covering coder training, documentation review and data quality fixes. The same section makes an annual external coding audit by a CHI-approved vendor mandatory from 1 January 2027, on top of quarterly internal audits.

The wider key performance indicators, including first-pass coding accuracy of at least 80%, sit in a table headed as proposed targets pending CHI confirmation, and the governance structure in section 10.2 reads "to be determined". The guideline commits to annual review, so a buyer should expect a second version before 2028.

Prostheses and implants, chemotherapy drugs, specialised devices, pre-admission emergency room services and follow-up care beyond 14 days after discharge are excluded from the reference price and billed separately. On our reading, that protects the biggest line items in cardiology, orthopaedic and oncology admissions, where a stent, a joint or a chemotherapy regimen continues to be billed as today. A hospital whose admissions are mostly medical, such as respiratory, infectious or general medicine, has more of its revenue inside the case price and more exposure to the negotiated base rate.

Room and board sit inside the reference price. Under fee-for-service another day in bed is another billed day; under a DRG it is cost against a fixed payment, subject to adjustment only where the stay falls outside the norm for that group.

The guideline says the trim points and adjustment formulas for those outliers will be published before full implementation in 2028. Until they are, any model of 2028 admitted-care revenue is missing a variable, and a hospital with long stays in its highest-volume DRGs carries a margin risk its fee-for-service accounts cannot show.

Ask the hospital for its monthly shadow-billing output: case mix index, error-DRG rate against the 3% cap, and DRG-versus-fee-for-service variance by payer. Confirm which approved vendor will run the 2027 external audit and read the last internal audit. Split admitted-care revenue into what sits inside the case price and what stays outside it, and value the inside portion on a base-rate range, not on fee-for-service history. That work sits with our business valuation practice.