Hospitals are experiencing underpayments on Transfer DRGs.

Transfer DRGs reduce payments for patients transferred early from acute care hospitals to post acute facilities. While edits are in place to ensure hospitals are not “overpaid”, no such mechanisms exist to identify underpayments. It's is up to you to identify instances when you are underpaid.

The number of DRGs impacted by the transfer payment rule has increased dramatically – and so too have underpayments. In fact, since 2004 the number of DRGs impacted by the rule has grown from 30 to 273.

Your facility is often paid at the transfer rate when entitled to the full DRG. Through no fault of your own, this occurs when the expected and prescribed post acute care is either never rendered or takes place beyond the defined regulatory guidelines. You have a right to recover these underpayments and may be pleasantly surprised by how far back you may go to correct underpaid claims.

SunStone can help.

We possess extensive transfer DRG reimbursement experience. Since 2005, we’ve performed dozens of reviews and recovered significant sums for our clients across the country. Our proprietary process employs thorough research techniques, ensuring both maximum recovery and compliance.

For more information about our Transfer DRG solutions, contact John Denniston at 717-671-6962 or via email at johndenniston@sunstoneconsulting.com.