Home Health & Hospice Week

 MAC collects $1 million for missed discharges to home care and other postacute providers.  

The OIG is hammering another Medicare contractor for failing to dock hospitals for patients who are discharged to home care, and the result could affect your referrals from those facilities.

Background: Under Medicare’s post acute transfer policy, hospitals’ Diagnosis Related Group 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. The Centers for Medicare & Medicaid Services expanded the policy to 273 DRGs in 2008. When the policy began in 1999, it applied to only 10 DRGs.

Initially, to work, the proration depended on hospitals’ coding at discharge, but the HHS Office of Inspector General called CMS on the carpet for paying for many full DRGs that should have been prorated under the policy (see Eli’s HCW, Vol. XVIII, No. 11). Then new edits went into place in 2008 that were supposed to catch the transfers, even if hospitals didn’t code them correctly.

But those edits still haven’t been identifying all the DRGs that should be prorated. The OIG called MAC Palmetto GBA to account in a report earlier this year (see Eli’s HCW, Vol. XXII, No. 22), and now it’s focusing on Jurisdiction 2 MAC Norid-ian Healthcare Solutions in a new report.

Noridian inappropriately paid 315 Medicare claims subject to the postacute care transfer policy from June 2009 through August 2012, the OIG says. The MAC for hospitals in four states (Alaska, Idaho, Oregon, and Washington) said that hospitals used incorrect patient discharge status codes on their claims, indicating that the patients were discharged to home or certain types of health care institutions rather than transferred to postacute care. "Conse-quently, Noridian overpaid the hospitals by $1.1 million," the OIG notes.

"Noridian made these overpayments be-cause the Common Working File (CWF) edits related to postacute transfers were not working properly," the OIG continues. "Noridian did not receive the automatic adjustments that identify overpayments on inpatient claims."

Noridian has recouped nearly all of the overpayments and is working with the FISS contractor to make sure its edits stay updated, it says in comments on the report at http://oig.hhs.gov/oas/reports/region9/91302035.pdf.