tci Medicare Compliance & Reimbursement - 2013 Issue 13

Reimbursement: MAC Overpays Hospitals For Post-Acute Transfers

Glitchy edit missed DRG prorates. Edits designed to catch transfers from hospitals to home care haven’t been working properly. Background: Under Medicare’s post acute transfer policy, hospitals’ DRG payments get prorated if they discharge a patient to home care before the median length of stay. The patient must go to home care within three days of discharge to trigger the proration. The Centers for Medicare & Medicaid Services (CMS) expanded the policy to 273 DRGs in 2008. When the policy began in 1999, it applied to only 10 DRGs. Initially, to work, the proration depended on hospitals&rsquo...

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