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Helping hospitals achieve fiscal fitness.
Medicare Transfer DRG's
Each year, hospitals lose significant revenue from underpayment of Medicare claims due to revisions in the transfer DRG rules.
Medicare transfer DRGs have been around since 1998, but until recently they affected only 10 DRG categories. In 2003, CMS expanded them to cover 30 DRGs. In 2005, they further expanded them to cover 182 DRGs – and last year they increased it to 190 DRGs.
The number of errors made in payment of these transfer DRGs can be significant.
Since 2004, CMS changed its policy to stop informing hospitals about any underpayment errors. Many hospitals are unaware they are losing money on transfer DRG payments.
When a hospital treats a Medicare patient, it is entitled to the full
DRG payment after it discharges that patient. However, if the
hospital sends the patient to another facility excluded from the
prospective payment system, a skilled nursing facility, or sends the
patient home with a written home health care plan, those cases are considered “transfers” not “discharges”. On transfers, the hospital gets paid a graduated per-diem rate for each day of the patient’s stay not to exceed the DRG rate. Often, this amounts to large discounts below the full DRG rate.
Unfortunately, some patients are misclassified as transfers when they were actually discharges. This means a loss of legitimate revenue for the hospital.
M. Leco & Associates has the software tools and the expertise to recover this revenue for you.
Act Now!
Time is limited to collect all monies rightfully due you
