Don’t Become a Target: Understand OIG Transfer DRG Audits

OVERVIEW

The Office of Inspector General (OIG) has conducted several reviews identifying Medicare overpayments to hospitals that did not fully comply with Medicare’s post-acute care transfer policy. The OIG found that some hospitals transferred inpatients to certain post-acute care settings, but coded the patient discharge status as a discharge to home. To obtain proper payment under the Medicare Severity-Diagnosis Related Group (MS-DRG) payment system, hospitals must be sure to code the discharge/transfer status of patients accurately, in order to reflect the patient’s level of post-discharge care. Due to labor shortages, hospitals are challenged now more than ever to validate patient discharge statuses. As a result, it is essential for acute care providers to implement an ongoing Transfer DRG compliance review program to decrease OIG overpayment exposure.

McBee experts, Edith Ragland and Kristina Grenaldo, will dive into the audit best practices and trends your organization should be aware of and plan for on an ongoing basis. In addition, we will review OIG Transfer DRG audit findings and recommendations.

LEARNING OBJECTIVES

• Understand why the OIG conducts Transfer DRG audits
• Analyze OIG audit findings
• Discover practices to follow and strategies to limit OIG overpayment exposure
• Implement an ongoing 01 Discharge to Home Validation Review

SPEAKERS