Inpatient Facility Coding & Compliance Alert

Question: What are the factors that can reduce a MS-DRG payment?

Illinois Subscriber

Answer: There are several factors which can reduce MS-DRG payments. Here are some of them:

• The beneficiary’s LOS (length of stay) is at least one day less than the geometric mean LOS for the MS-DRG;
• The beneficiary is transferred to another hospital covered by the Acute Care Hospital IPPS or, for certain MS-DRGs, discharged to a post-acute setting;
• The beneficiary is transferred to a hospital that does not have an agreement to participate in the Medicare Program (effective October 1, 2010); and
• The beneficiary is transferred to a CAH (critical access hospital) (effective Oct. 1, 2010).