Inpatient Facility Coding & Compliance Alert

Question: Our hospital received a patient having seizures with MCC from another acute care facility downtown. The patient was assigned an MS DRG 100 (Seizures with MCC). How would the reimbursement be shared between the two hospitals?

Virginia Subscriber

Answer: Hospitals generally receive adjusted reimbursement if the patients covered under Medicare are shifted to another acute-care hospital or to a post-acute care hospital. When patients are shifted from one acute-care facility to another, the hospital that transfers the patient is to be reimbursed an MS-DRG-based per-diem rate. The facility that receives the patient is entitled to the full MS-DRG reimbursement.  Your MS-DRG meets the post-acute care transfer criteria.