Discharge Codes: Impact on the Post-Acute Care Transfer Policy - Risks and Rewards
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Gain an understanding of the post-acute care transfer policy in order to maintain compliance.As the inescapable expansion in oversight and investigation of health care claims continues, the Post-Acute Care Transfer Policy introduces obscure risks for providers that could result in Medicare program recoupments if not monitored. The HHS Office of Inspector General (OIG) has issued a series of reports which highlight what it believes to be improper payments to acute care hospitals for claims subject to the Post-Acute Care Transfer Policy. This topic helps clarify the Post-Acute Care Transfer Policy to facilitate hospitals' proactive identification of potential issues and avoid surprising retrospective paybacks. Specifically, it will address approaches to monitoring and auditing intended to identify potential issues as well as address their root causes. This information is critical for hospitals to eliminate a potential blind spot in their compliance strategy.
AuthorsPeter Dressel, FTI Consulting, Inc.
Policy Basics and the Role of Discharge Codes
• Identifying the Cases to Which the Policy Applies
• Understanding How the Policy Works
• Discussion of Recent Developments
Understanding the Risk Areas and Their Drivers
• Claims Indicating a Discharge to Home
• Condition Codes Usage
• What About Common Working File Edits?
Approaches for Proactively Addressing the Risks
• Monitoring Approaches Utilizing Internal Data Sources
• Audit Considerations