Home Health & Hospice Week

The HHS Office of Inspector General wants to make sure no full payments for hospital patients discharged “early” to home are sneaking through. And the result may chill hospital referrals for certain patients.

Reminder: “Medicare makes the full Medicare Severity Diagnosis-Related Group (MS-DRG) payment to a hospital that discharges an inpatient beneficiary ‘to home,’” the OIG says in a new recent addition to its Work Plan. “However, for certain qualifying MS-DRGs under the post-acute-care transfer policy, Medicare pays hospitals a per diem rate when an inpatient beneficiary is transferred to post-acute care.”

The Common Working File claims system was missing some of those prorated DRG payments when the OIG checked in an earlier audit, and now the watchdog agency plans to circle back and make sure the problem is fixed — notably, that “CMS’s CWF edits are working properly … and are automatically recovering overpayments,” and that “Medicare contractors are receiving the automatic notifications and acting to recover overpayments.”

See the Work Plan item details at https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000707.asp.