An “acute care transfer” occurs when a Medicare beneficiary in an IPPS hospital (with any MS-DRG) is: Transferred to another acute care IPPS hospital or unit for related care - Patient Discharge Status Code 02 (or 82 when an Acute Care Hospital Inpatient Readmission is planned); or
What is a post acute care transfer under Medicare?
Feb 22, 2021 · An acute care transferoccurs when a Medicare patient in an IPPS hospital (with any MS- DRG) is: 1. Transferred to another acute care IPPS hospital or unit for related care (Patient Discharge Status Code 02 or Planned Acute Care Hospital …
What is the status code for readmitted to another hospital?
Feb 18, 2021 · If the facility has some Medicare certified beds you should use patient status code 03 or 04 depending on the level of care the patient is receiving and if they are placed in a Medicare certified bed or not. 65. Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital. 66.
Can You bill Medicare for two codes on the same day?
Dec 18, 2019 · To avoid billing errors in a transfer situation, the receiving agency must enter a condition code (FL 18-28) "47" on the first RAP and claim that is billed for the beneficiary after the transfer is completed. Receiving agencies are reminded that it is not appropriate to bill a condition code 47 if they have not followed the "receiving home health agency responsibilities" outlined …
When to code a hospital discharge to a subsequent facility?
An “acute care transfer” occurs when a Medicare beneficiary in an IPPS hospital (with any MS-DRG) is: 1. Transferred to another acute care IPPS hospital or unit for related care - Patient Discharge Status Code 02 (or 82 when an Acute Care Hospital Inpatient Readmission is …
When a patient is transferred from one facility to another?
inter-agency: moving a patient from one health care facility to another.
What is discharge status code 63?
63. Discharged/transferred to a Medicare certified long term care hospital (LTCH) 64. Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare.Jan 18, 2022
When would you use condition code 43?
Condition Code 43 may be used to indicate that Home Care was started more than three days after discharge from the Hospital and therefore payment will be based on the MS-DRG and not a per diem payment.Nov 17, 2015
What is Medicare Transfer DRG?
Because they felt Medicare was paying twice for the treatment of certain patients, CMS officials adopted the Post-Acute Transfer (PACT) rule. Certain DRGs (known as Transfer DRGs) are paid under the Medicare Post-Acute Care Transfer Rule.May 28, 2014
What does condition code 42 mean?
Condition Code 42 - used if a patient is discharged to home with HH services, but the continuing care is not related to the condition or diagnosis for which the individual received inpatient hospital services.Dec 1, 2020
What does discharge status 70 mean?
The. NUBC approved patient status code 70 and defined it as “discharge/transfer to another type of health care. institution not defined elsewhere in the code list.” This code is effective for use by providers for discharges.Nov 2, 2007
What does condition code 08 mean?
refusalEnter condition code 08 to indicate refusal. Depending on the services provided, the claim may return to provider as beneficiary liable.Feb 15, 2016
What does condition code 51 mean?
attestation of unrelated outpatient non-diagnostic servicesCondition code 51 (attestation of unrelated outpatient non-diagnostic services”) is not included on the outpatient claim. The line item date of service falls on the day of admission or any of the 3-days/1-day prior to an inpatient hospital admission.Dec 7, 2020
What does Condition Code C5 mean?
Any medical reviewC5 Any medical review will be completed after the claim is paid. UB04 Condition Code. C6 The QIO authorized this admission/procedure but has not reviewed the services provided.
Does Medicare pay for hospital transfer?
Medicare will only cover ambulance services to the nearest appropriate medical facility that's able to give you the care you need.
What is the discharge status code for a patient transferred to a skilled nursing facility?
03 - Discharged/Transferred to a Skilled Nursing Facility (SNF) with Medicare Certification in Anticipation of Skilled Care. This code indicates that the patient is discharged/transferred to a Medicare certified nursing facility in anticipation of skilled care.Mar 8, 2017
What is post-acute transfer?
So, as a quick refresher, the Post-Acute Transfer Policy says that whenever a patient is discharged within certain DRGs, if it's below the geometric mean length of stay, if they are transferred to a hospital or a hospital distinct part unit, a skilled nursing facility or home care within three days and hospice, 50 or ...Sep 12, 2018
Does Medicare reimburse home health agencies?
Medicare will only reimburse the primary home health agency for home health services during an episode. When a beneficiary decides to transfer to another HHA, refer to the following information, depending upon whether you are the transferring or receiving agency.
Can you transfer a home health plan to another?
Beneficiaries under a home health plan of care may choose to transfer from one home health agency (HHA) to another at any time. Medicare regulations permit them to do so as often as they choose. Under Home Health Prospective Payment System (HH PPS) consolidated billing requirements, there can only be one primary home health agency that establishes a plan of care for beneficiaries (who meet the coverage requirements), provides all home health-related services (either directly or under arrangement), and bills Medicare for reimbursement. Medicare will only reimburse the primary home health agency for home health services during an episode.
What is OC 27?
The date used with OC 27 is based on which benefit period the claim falls within or overlaps. If a patient is in the first certification period when they transfer, the receiving hospice would report OC 27 with the same certification date as the previous hospice.
Can a hospice beneficiary change the designation of the hospice?
Once in each benefit period, a hospice beneficiary may change the designation of the hospice he/she wishes to receive care from. You can check to see if the beneficiary has already transferred once within the current benefit period by:
What is discharge status code 50?
Patient discharge status Code 50 should be used if the patient went to his/her own home or an alternative setting that is the patient’s “home,” such as a nursing facility, and will receive in-home hospice services.
What is LTCH code?
This code is for hospitals that meet the Medicare criteria for LTCH certification. LTCHs are facilities that provide acute inpatient care with an average length of stay of 25 days or greater.
What is an inpatient rehabilitation facility?
Inpatient rehabilitation facilities (or designated units) are those facilities that meet a specific requirement that 75% of their patients require intensive rehabilitative services for the treatment of certain medical conditions. This code should be used when a patient is transferred to a facility or designated unit that meets this qualification.
Can a nursing facility certify a bed under Medicare?
Nursing facilities may elect to certify only a portion of their beds under Medicare, and some nursing facilities choose to certify all of their beds under Medicare. Still others elect not to certify any of their beds under Medicare.
When is Medicare verification required?
Medicare providers are expected to verify a beneficiary's Medicare eligibility at the time of or prior to admission to ensure that the patient is eligible to receive the services covered by Medicare.
Can SNF be paid for discharge?
The transferring SNF cannot be paid for the actual date of transfer. The receiving SNF can be paid for the date of the transfer, but not the date of discharge. SNF s should also ensure that they are submitting their discharge claims with the appropriate discharge status code.
Can a hospital bill Medicare?
The hospital may not bill Medicare, but must look to the LTCH for payment of services. The only exception to this rule is when treatment at an inpatient acute care hospital would be grouped to a surgical DRG. See CMS IOM, Publication 100-04, Chapter 3, Section 150.9.1.2.
Can a hospital be paid for a transfer?
The transferring hospital cannot be paid for the actual date of transfer. The receiving hospital can be paid for the date of the transfer, but not the date of discharge.
Skilled Nursing Facility (SNF) same day transfer
When the patient admits to a SNF and is expected to remain overnight, but was transferred to another participating provider (acute care hospital or another SNF) before the following midnight.
Common Errors
1. A claim is billed with patient discharge status codes 01 (patient discharged to home or self-care); however the beneficiary was transferred to another facility. An adjustment needs to be submitted to correct patient status code.