Greetings!
As Charles Darwin observed, "It is not the strongest of the species that survive, but those that adapt the quickest to change." Healthcare providers that respond quickly to change, will add reimbursement to their bottom line. |
| Reimbursement Underpayments
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| When a post acute transfer DRG could have been paid at a full DRG rate, but was prorated, hospitals may be underpaid. These underpayments are NOT reported to the hospital by the Fiscal Intermediary or Medicare Administrative Contractor (MAC). It is the hospital's responsibility to research, identify and recover these known DRG underpayments. Add this to the fact that the recent growth of transfer DRGs from 30 to 190 caused underpayments to triple from $600 million in FFY 2004 up to $2 billion in FFY 2006. In FFY 2008 this number has grown from 190 to 273 DRGs. It becomes clear that the post acute transfer DRGs must be managed and tracked to ensure payment accuracy.
Don't let CMS keep your money in their bank. |
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Incorrect Payments 2008
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| OIG reports cite a 95% error rate on post acute transfer DRG payments.
Just released is the CMS Transmittal 1405, Change Request 5845 dated January 4, 2008 which identifies those post acute care transfer DRGs which should have received a special pay transfer payment processed in error. Recently, CMS has corrected this error in the IPPS pricer. On February 4, 2008 CMS directs contractors to implement the reprocessing of claims with discharges on or after October 1, 2007.
DRGs impacted by the ruling are listed here: 28, 29, 30, 40, 41, 42, 219, 220, 221, 477, 478, 479, 480, 481, 482, 492, 493, 494, 500, 501, 502, 515, 516, 517, 956
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Cirius Group reimbursement solutions are designed to specifically help you systemize data for better tracking and analysis of payment variances. In this rapidly changing regulatory environment allow us to optimize your financial performance with these tried and true reimbursement software solutions.
Sincerely,
Jayne Kroner
Cirius Group, Inc.
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| Discharge Status Impacts Hospital Transfer Policies |
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The IPPS Acute to Acute Transfer Policy applies to transfers coded with patient discharge status code '02' and applies to ALL diagnosis-related groups (DRGs) and when the length of stay is less than the average length of stay for the DRG.
Based on the above, the IPPS Post Acute Care Transfer Policy applies to claims coded with patient discharge status codes 03, 05, 06, 62, 63 and 65.
IRF Transfer Policy applicable for patient discharge status codes for IRF PPS. Status codes are 02, 03, 61, 62, 63, and 64.
Omitting a discharge code or submitting a claim with an incorrect code is a claim billing error and could result in the provider's claim being rejected or their claim being cancelled and a payment being taken back.
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Cirius Reimbursement
Software
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Cirius provides Prospective Payment System (PPS) calculations on outpatient and MS-DRGs on inpatient Medicare claims - essential to achieving cost savings.
Key features
Identify payment variances
Validate and manage cost reports
Provides a powerful audit support
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