Transfer DRG reimbursement opportunities are difficult to locate among thousands of patient accounts. For that reason, HORNE partners with a well established data clearing house to review transfer DRGs for potential coding misclassifications. HORNE reviews your Medicare claims that come under the Post Acute Care Transfer Policy and identifies those claims with recovery potential. This recovery potential affords your hospital the opportunity to increase hospital revenues and strengthen your bottom line.
Since the Centers for Medicare and Medicaid Services (CMS) has not addressed the issue of underpayments, it is the responsibility of each hospital to identify underpayments. HORNE has established a proven methodology for identifying patients transferred to post-acute care where Medicare payment may be less than what your hospital was entitled to receive. With the experience and technical resource to provide hospitals with the assurance that the recovery effort is appropriate, HORNE's approach allows for a comprehensive review with minimum impact on your operations.
HORNE's process includes:
- Review of all relevant claims
- Identification of recovery opportunities
- Provision to the hospital of claims to be adjusted
- Verification of acceptance of the corrected claim after the hospital adjusts the claims
Examples of common misclassification scenarios to the TDRG Policy for a discharged subject are:
- Transfer to a hospital or distinct part hospital unit excluded from the prospective payment system such as psychiatric or rehabilitation. For example, when a patient is discharged from a hospital with the expectation of transfer to a psychiatric facility and leaves the discharge area against medical advice.
- Transfer to a Medicare-certified skilled nursing facility. For example, a patient goes to assisted living or other non-Medicare certified bed.
- Transfer home under a written plan of care for the provision of
home health services from a
home health agency and those services begin within three days after the date of discharge. For example, a patient went home and refused any treatment except from spouse.