Inflating LOS for transfer rule DRGs could lead to federal fraud charges.
A year after the Health Care Financing Administration implemented its controversial transfer payment policy, some hospitals are keeping patients in the hospital longer than necessary in order to receive full DRG payments. That's a risky strategy, say some experts, who warn that inflating length of stay (LOS) solely for financial reasons could provoke a federal fraud investigation. At St. John's Medical Center in Tulsa, OK, case managers haven't attempted to increase LOS in response to the new transfer rule, but they have put the brakes on any additional cuts in LOS for patients in the 10 affected DRGs. Meanwhile, at Elkhart (IN) General Hospital, case managers have made no adjustments, despite losing as much as $200,000 as a result of the transfer rule. Deborah Hale, president of Administrative Consultant Services in Shawnee, OK, suggests that the best approach for case managers eager to offset losses in reimbursement due to the transfer payment policy is to save money by focusing on patients with complicated conditions who traditionally have had longer-than-average lengths of stay.
D014487:Centers for Medicare and Medicaid Services, U.S.; D003953:Diagnosis-Related Groups / Q000191:economics*; D005377:Financial Management, Hospital / Q000331:legislation & jurisprudence*; D005607:Fraud / Q000331:legislation & jurisprudence*; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D010360:Patient Transfer / Q000191:economics*; D011641:Public Relations; D019467:Subacute Care / Q000191:economics; D014481:United States