BC Advantage - 2015 Issue 9

Compliance Risks and Transfer DRGs

A major challenge facing hospitals today is developing and implementing the most efficient and effective procedures to ensure that they are getting properly reimbursed for services rendered. This is especially critical when it relates to revenue related to claims impacted by the post-acute transfer rule (PACT). Identifying such underpayments can be a rather convoluted process. To ensure proper payments, a hospital must be able to allocate the resources to audit all claims impacted by the PACT to determine if the correct discharge status was utilized based upon the care the patient "actually" received post discharge. There are a number...

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