The Scoop on Transfer DRGs
Prior to October 1, 2005, a discharge of a hospital inpatient was considered to be a "transfer" for Medicare payment purposes when the patient’s discharge was assigned to one of thirty (30) DRGs as described in 42 C.F.R. § 412.4(d) and the patient was discharged to: a hospital or hospital unit that was excluded from PPS, a skilled nursing facility (SNF) or the patient’s home when there was a written care plan for home health services (the services related to the condition or diagnosis for which the individual received inpatient hospital services and those services began within three days after the date of discharge).
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RAC Coming to a Provider Near You
CMS initiated a pilot Recovery Audit Contractors (RACs) program in 2005. The initial states that were selected for this pilot were California, New York and Florida. These states were selected primarily because they are the largest states in terms of Medicare utilization. Approximately 25 percent of Medicare payments made each year is to providers in these states. The mission of the RACs is "To reduce Medicare improper payments through the efficient detection and collection of overpayments, the identification of underpayments and the implementation of actions that will prevent future improper payments."
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