Transfer MS-DRG Review Solutions
Hospitals are experiencing underpayments and may have a compliance risk if not paying close attention to Transfer MS-DRGs.
Transfer MS-DRGs reduce payments for patients transferred early from acute care hospitals to post-acute care facilities. While edits are in place to detect transfers that were improperly coded as discharges to home thereby ensuring that hospitals are not “overpaid”, there are no similar edits to ensure that hospitals are not underpaid. Hospitals are therefore forced to be proactive in identifying cases in which they were potentially “underpaid”.
The number of MS-DRGs impacted by the transfer payment rule has increased dramatically, and so too have underpayments. In fact, since 2004 the number of MS-DRGs impacted by the rule has grown from 30 to nearly 300.
Your hospital is often paid at the transfer rate when entitled to the full MS-DRG payment. 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.
COMPLIANCE
It is important to have a thorough understanding of the post-acute care transfer policy, and if necessary, to partner with a firm that does. SunStone will verify discharge disposition codes aggressively and accurately and most importantly ensure that the hospital is receiving appropriate reimbursement. No more – no less!
GETTING STARTED
We are pleased to offer a free, no-risk estimate. Please contact us to learn more.