Postacute transfer payment: how often are hospitals being underpaid?
The postacute transfer rule was implemented to stop what CMS perceived as double payment for certain DRGs that frequently result in a transfer from a hospital to a postacute care facility. Often, patients are coded as having been discharged to a qualifying postacute care facility when in fact the patient either does not receive the anticipated care or does not receive it within the required regulatory time frame. Hospitals have a right to review all paid acute care inpatient claims for services delivered under transfer DRGs to verify that postacute care was actually provided, and recover payment if the postacute care was not provided within the required time frame.
Scarcelli
Anthony J
AJ
IMA Consulting, Chadds Ford, PA, USA. tscarcelli@ima-consulting.com
Schitter
Scott D
SD
D000208:Acute Disease; D014487:Centers for Medicare and Medicaid Services, U.S.; D003266:Continuity of Patient Care / Q000191:economics; D004469:Economics, Hospital; D006801:Humans; D010360:Patient Transfer / Q000191:economics*; D020444:Reimbursement, Disproportionate Share / Q000191:economics*; D014481:United States