Transfer DRG Services

In 1999, the Centers for Medicare and Medicaid Services (CMS) initiated a reimbursement methodology related to certain Diagnostic Related Groups (DRGs) involving transfers to post-acute care facilities (e.g., SNF or rehab facility) or to home health care.  Since it was paying the acute care facility at the full DRG rate, and then subsequently paying the post-acute care facility or home health agency a full payment as well, CMS determined that inaccurate overpayments were occurring in many instances.  Instead of receiving the full DRG, the hospital payment was based on a per diem for the DRG.  Initially, 10 DRGs were involved, eventually increasing to 273.

In an effort to address these inpatient overpayment issues, “Transfer DRGs” were established, with corresponding edits, checks and balances incorporated into the CMS payment systems.  Known as the “transfer rule,” a hospital received a reduced reimbursement if the patient had a length of stay more than one day less than the geometric length of stay for that particular DRG, and if the patient was transferred to another post-acute care facility (such as skilled nursing or home health).
 
OIG stated in their 2008 Work Plan that they would be reviewing patient discharges that should have been coded as transfers rather than discharges.  As a result, compliance issues with Transfer DRG regulations are becoming even more prevalent and important for providers and the potential negative impact on a hospital’s reimbursement for Transfer DRG’s continues to grow.

MCare was the first company to provide Transfer DRG Reimbursement Recovery Services to client facilities, enabling those clients to realize all reimbursements for transfer DRGs to which they are entitled.

MCare’s initial focus on Transfer DRG reimbursement for Medicare fee-for-service claims in hospital acute care settings has expanded to include acute care discharges related to Medicare Advantage payers and reimbursement recoveries for IME/GME payments owed to teaching hospitals for Medicare Advantage claims.