Medicare Compliance & Reimbursement

Hospitals:

19 DRGs ON PER-DIEM CHOPPING BLOCK

Hospitals have long grumbled over the Centers for Medicare & Medicaid Services' post-acute transfer policy. But if an upcoming CMS proposal gets finalized, the policy will apply to nearly three times as many diagnosis related groups.

Under the transfer policy, when patients with certain conditions are discharged to a post-acute care setting, the hospital is paid a per diem rate rather than the full DRG amount. Currently, 10 DRGs are subject to the policy - but in an inpatient prospective payment system update unveiled May 9, CMS proposes to add 19 new DRGs to the existing 10.

The new DRGs are:

  • 12 Degenerative Nervous System Disorders
  • 24 Seizure and Headache Age >17 With CC
  • 25 Seizure and Headache Age >17 Without CC
  • 89 Simple Pneumonia and Pleurisy Age > 17 With CC
  • 90 Simple Pneumonia and Pleurisy Age > 17 Without CC
  • 121 Circulatory Disorders With AMI and Major Complication, Discharged Alive
  • 122 Circulatory Disorders With AMI and Without Major Complication, Discharged Alive
  • 130 Peripheral Vascular Disorders With CC
  • 131 Peripheral Vascular Disorders Without CC
  • 239 Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy
  • 243 Medical Back Problems
  • 277 Cellulitis Age >17 With CC
  • 278 Cellulitis Age >17 Without CC
  • 296 Nutritional and Miscellaneous Metabolic Disorders Age >17 With CC
  • 297 Nutritional and Miscellaneous Metabolic Disorders Age >17 Without CC
  • 320 Kidney and Urinary Tract Infectious Age >17 With CC
  • 321 Kidney and Urinary Tract Infectious Age >17 Without CC
  • 462 Rehabilitation
  • 468 Extensive O.R. Procedure Unrelated to Principal Diagnosis

    Lesson Learned: Hospitals should prepare for the possibility that Medicare could start applying post-acute transfer policies to a new slate of DRGs.

     

  • Other Articles in this issue of

    Medicare Compliance & Reimbursement

    View All