Home Health & Hospice Week

You may see increased pushback from hospitals that had eluded proration of DRGs for patients discharged to home care.

"A post-acute transfer edit in the Fiscal In-termediary Standard System (FISS) has been updated to add the home health agency CMS Certification Number (CCN) range XX9500 - XX9799," explains HH Medicare Administrative Contractor National Government Services in a message to providers. "Inpatient Prospective Payment System (IPPS) acute hospital claims in history with a discharge to home that did not edit when a home health claim was present in claims history will be adjusted to change the patient status code to ensure it accurately applies the IPPS post-acute transfer policy," NGS says in the message.

In a report last year, the HHS Office of In-spector General highlighted the problem of the claims system failing to prorate hospital DRG payments when the post-acute transfer provision applied (see Eli’s HCW, Vol. XXII, No. 22).

Reminder: Under Medicare’s post acute transfer policy, hospitals’ DRG payments get prorated if they discharge a patient to home care before the median length of stay. The patient must go to home care-within three days of discharge to trigger the proration. CMS expanded the policy to 273 DRGs in 2008. When the policy began in 1999, it applied to only 10 DRGs.