Medicare Now Considers Hospice Care a Post-acute Transfer

Medicare Now Considers Hospice Care a Post-acute Transfer

Starting Oct. 1, hospital discharges to hospice care qualify as a post-acute care transfer and may have payment adjustments for Medicare patients.

According to the Centers for Medicare & Medicaid Services (CMS) Transmittal 2055, change request 10602, under the policy regulations § 412.4:

  • * When a patient is transferred to another hospital and their stay is less than the geometric mean length of stay for the Medicare Severity Diagnosis-related Group (MS–DRG), the transferring hospital is paid based on a graduated § 412.4 rate for ceach day of stay, not to exceed the full MS–DRG payment.
  • * For discharges to certain post-acute (hospice) care settings, this per diem-based payment adjustment is limited to discharges to certain MS-DRGs.

This policy is a change from the current regulation which does not consider hospice a post-acute transfer. Instead, post-cute transfer has been limited to distinct hospital units, skilled nursing facilities, and discharges with a written plan for home health services within three days of discharge.

CMS requires Medicare Administrative Contractors (MACs) to:

  • * Add hospice to the logic of edit and IUR 7272 to ensure a transfer to a hospice is included in the post-acute transfer payment policy logic.
  • * Update the Inpatient Prospective Payment System (IPPS) Pricer logic to set review code 09 when all three conditions are met:
    • 1.) The patient status equals 50 or 51;
    • 2.) Condition code 66 is not present; and
    • 3.) The statement covers a date on or after Oct. 1.
  • * Update the logic for the IPPS Pricer to set review code 11 when all three conditions are met:
    • 1.) The patient status equals 50 or 51;
    • 2.) Condition code 66 is present; and
    • 3.) The statement covers a date on or after Oct. 1.

MACs will receive a beta version of the October 2018 IPPS Pricer around June 4.

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Michelle Dick
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Michelle Dick

Michelle A. Dick, BS, is a freelance content specialist, providing writing, editorial expertise, and graphic imagery to clients. Prior to becoming a free agent, she was an executive editor for AAPC, editor-in-chief at Eli Research, and editor at Element K Journals. After earning a Bachelor of Science from the State University of New York at Buffalo State, Dick entered the publishing industry as a graphic artist, ad coordinator, and web designer for White Directory Publishers, Inc.
Michelle Dick
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About Has 261 Posts

Michelle A. Dick, BS, is a freelance content specialist, providing writing, editorial expertise, and graphic imagery to clients. Prior to becoming a free agent, she was an executive editor for AAPC, editor-in-chief at Eli Research, and editor at Element K Journals. After earning a Bachelor of Science from the State University of New York at Buffalo State, Dick entered the publishing industry as a graphic artist, ad coordinator, and web designer for White Directory Publishers, Inc.

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