Medicare Transfer DRG
*Leave No Cash Behind*
Is your Hospital taking advantage of every legitimate revenue recovery opportunity? Since 2006, BESLER Consulting has assisted healthcare providers in recovering significant revenue subject to the requirements of the Medicare post-acute transfer policy. Our process is compliance driven and focused on maximizing your revenue recovery opportunity. Our staff brings, on average, over 20 years of healthcare experience in revenue recovery, reimbursement, coding, and compliance areas. By focusing on the healthcare industry, the Besler team has developed an efficient and compliant driven service which is minimally invasive to your staff.
RESULTS DRIVEN
Your Transfer DRG recoveries can be significant!
Our process consistently results in additional recoveries in excess of 30% over our competitors and providers that perform this work internally. We currently serve over 100 clients in 17 states.
Already reviewing and submitting claims? Consider a second sweep.
BESLER Consulting has been conducting a “second sweep” for providers looking to validate their internal process or audit their experts. On average, our compliance driven process results in recoveries of an additional 30% over and above what the first pass has yielded.
What should you do?
Assess all Medicare (acute inpatient) claims against the relevant transfer DRGs: (182 for FFY 2006 and 190 for FFY 2007 and 273 for FFY 2008).
Verify post-discharge care provided and timeliness.
Calculate applicable underpayment.
Adjust claims to recover underpayments.
what BESLER will do for you:
Identify the cases subject to the transfer rule using our proprietary systems and process.
Confirm the post-acute care provided.
Ensure the case is eligible for recovery.
Compute the applicable underpayment and provide documentation.
Adjust claims in a timely manner to expedite your cash recovery.
What’s new from CMS?
Proposed Changes To The Post-Acute Transfer Policy:
When the DRG classification was replaced by the MS-DRG classification in the FY 2008 IPPS final rule, CMS made conforming changes to the criteria for subjecting MS-DRGs to the post-acute transfer policy. The FY 2010 IPPS final rule applies the post-acute transfer policy to 273 MS-DRGs, the same number as were subject to the policy in the FY 2008 IPPS final rule. Of these, 24 MS-DRGs qualify as special pay post-acute transfer DRGs (approximately the same number as in FY 2008). These MS-DRGs, most of which are surgical MS-DRGs, tend to have higher costs during the first days of the stay. Under the general post-acute transfer policy, the transferring hospital will be paid 50 percent of the total IPPS payment plus the average per diem for the first day of the stay. For the special pay MS-DRGs, the transferring hospital will also receive 50 percent of the per diem amount for each subsequent day of the stay, up to the full MS‑DRG payment amount. The final rule also applies the post-acute transfer policy to discharges to home under a written plan for the provision of home health services that begins within 7 days after the day of the discharge if the discharge from the hospital occurred prior to the Geometric Mean Length of Stay (GMLOS) for one of the selected MS-DRGs.