Health Information Management

PPV: Audit postacute transfers to ensure proper payment

HIM-HIPAA Insider, July 16, 2007

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CMS has edits in place to alert your facility when it inappropriately receives the full DRG payment following a transfer from your hospital. This may occur when a patient--unbeknownst to you--seeks additional care after being discharged, resulting in a compliance and payment problem.

However, there is also a reimbursement angle to postacute transfers. If you transfer a Medicare patient to another facility or agency for care, and he or she does not receive the intended postacute care, your facility receives a lower DRG payment--even though you are entitled to receive the full amount. Are you tracking all of the reimbursement that you lose when you transfer patients and they don't receive that subsequent care?

Editor's note: For more information on how to audit postacute transfers, click here. Subscribers to Briefings on Coding Compliance Strategies can read the full article in the July 2007 issue. You can also purchase this article for $10.

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