Coding, Classification and Reimbursement

Transfer DRGs

  • 1.  Transfer DRGs

    Posted 11-15-2018 10:05

    Has anyone implemented a successful program that addresses post discharge placement in Home Health, Skilled Nursing or an Inpatient Rehab facility within 72 hours of discharge when the plan of care indicates that the patient's disposition is to home?  This is happening more frequently and we only find out about it when Medicare recalls their payment.  I would appreciate your comments.


    Thank you.


    Indra D. Osi, RHIA, CHP

    Director, Coding and Reimbursement

    Cleveland Clinic

    216-442-1282 (o) 216-970-4338 (c)



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  • 2.  RE: Transfer DRGs

    Posted 11-27-2018 11:46
    ​The Medicare claims processing manual (ch 3) only stipulates transfer adjustments within 3 days of discharge for home health.  I would question any adjustments for SNF or other discharge dispositions that did not occur on the day of discharge.

    Regarding home health dispositions, be sure someone in the facility is also communicating with the business office to identify cases where condition code 42 (patient is returning to home health but the reason for home health services was not associated with the reason for the inpatient admission) or condition code 43 (home health services were not initiated within 3 days of inpatient discharge) are applicable.  DRG payments are not reduced with home health discharges in transfer DRGs when either of these condition codes are present on the claim.

    Susan Wallace
    VP of Inpatient Services
    Administrative Consultant Service, LLC