The Centers for Medicare and Medicaid Services (CMS) pays for Medicare inpatient hospital care on the basis of Diagnosis Related Groups (DRGs). Certain DRGs (known as Transfer DRGs) are paid under the Medicare Post Acute Care Transfer Rule (Transfer Rule), which reduces payments for hospitals that transfer patients to other providers to continue treatment.
In a significant number of cases, patients are not treated as planned after being transferred, or an inaccurate discharge status code is assigned to the claim. These factors result in an unwarranted reduction in the transferring hospital’s Medicare payment. The impact to US hospitals is in the hundreds of millions of dollars per year.
Properly reviewing the post‐transfer care that patients receive and identifying underpayment situations can provide hospitals with a significant revenue boost. However, it’s important to identify and address these situations in a manner that is compliant.
This white paper discusses solutions that allow hospitals to recover the revenue they’ve properly earned when they’ve been underpaid due to the Transfer Rule. Many of the issues and solutions discussed in this white paper also apply to Medicare Advantage transfer claims.
Complete the form to download the Transfer DRGs: Approaches to Revenue Recovery white paper.
Transfer DRGs: Approaches to Revenue Recovery white paper.