Case Management

Pay attention to transfer DRGs and discharge status codes

Case Management Monthly, February 1, 2011

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The inpatient prospective payment system (IPPS) rewards hospitals for achieving a low LOS, but not in every case. There are specific MS-DRGs, called transfer DRGs, that can trigger certain transfer rules that cause a hospital to receive a reduced rate for early discharges to specific locations. 

As part of the discharge planning process, hospitals should identify discharges that will trigger the transfer rules and report the appropriate discharge status codes on the inpatient claim for that stay, says Sandra McCune, BSN, RN, utilization management specialist at Lakeland HealthCare in St. Joseph, MI. 

Transfers from one acute care facility to another for care that is related to the initial stay will trigger specific transfer rules, says Debbie Mackaman, RHIA, CHCO,  regulatory specialist for HCPro, Inc., in Danvers, MA. These rules mean that if the hospital transfers the patient before his or her LOS meets the geometric mean LOS (GMLOS), the hospital may receive a reduced DRG payment. 

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