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.

Certified Inpatient Coder CIC

Looking to Validate Your Inpatient Coding Expertise?

Certified Inpatient Coder (CIC™) is the new inpatient medical coding certification standard, dedicated exclusively to inpatient hospital/facility coding.

Michelle Dick
Follow me

Michelle Dick

Executive Editor at AAPC
Michelle A. Dick has been executive editor for AAPC for over 10 years. Prior to her work at AAPC, she was editor-in-chief at Eli Research and Element K Journals, and disk ad coordinator, web designer/developer, and graphic artist at White Directory Publishers, Inc. She has a Bachelor of Science in Graphic Design from the State University of New York - Buffalo State and is a member of the Flower City Professional Coders in Rochester, N.Y.
Michelle Dick
Follow me

About Has 226 Posts

Michelle A. Dick has been executive editor for AAPC for over 10 years. Prior to her work at AAPC, she was editor-in-chief at Eli Research and Element K Journals, and disk ad coordinator, web designer/developer, and graphic artist at White Directory Publishers, Inc. She has a Bachelor of Science in Graphic Design from the State University of New York - Buffalo State and is a member of the Flower City Professional Coders in Rochester, N.Y.

Leave a Reply

Your email address will not be published. Required fields are marked *