tci Medicare Compliance & Reimbursement - 2005 Issue 23
HOME HEALTH: Hospital Transfer Policy Could Choke Off Referrals
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Article Overview
This article covers a CMS proposal in the fiscal year 2006 hospital inpatient PPS rule that would broaden the Medicare hospital post-acute transfer policy and increase the number of affected DRGs. It is relevant to home health agencies, hospitals, discharge planners, and revenue cycle staff who track post-discharge care patterns and payment policy changes. The discussion also touches on related CMS monitoring activity, OIG findings, and the broader operational impact on referral flow and hospital behavior.
Why This Topic Matters
Payment policy changes tied to post-acute discharge can alter hospital reimbursement and influence how quickly patients are discharged, which directly affects home health referral patterns and post-acute care planning. Understanding the scope of the proposed expansion helps providers anticipate operational and financial effects.
Article Sections
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CMS proposal to expand the post-acute transfer policy
Overview of the proposed Medicare inpatient payment change and the general purpose of the post-acute transfer policy. The section frames the scope of the policy discussion within the hospital PPS rulemaking process.
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Potential impact on home health agencies and hospitals
Discussion of how the proposed expansion could affect referral patterns, discharge planning, and hospital use of affiliated post-acute resources. The section presents stakeholder concerns and anticipated operational effects.
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Hospitals fighting the expansion
Summary of perspectives suggesting the practical effect of the proposal may be narrower than expected. The section notes the debate over which cases would actually be affected.
What You Will Learn
- The policy area addressed by the CMS proposal
- How hospital payment changes can affect post-acute care relationships
- Why home health and hospital stakeholders are watching the proposed rule
- The role of CMS monitoring and OIG findings in the transfer policy discussion
Who Should Read This
- Home health agencies
- Hospitals and health systems
- Hospital discharge planners
- Medicare payment analysts
- Revenue cycle and compliance staff
Code Ranges Discussed
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