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As many hospitals are aware, CMS implemented
a new coding edit that has led to the cancellation/denial
of thousands of inpatient claims when the inpatient
discharge status does not match services that
patients later receive in post-acute settings
including SNF, rehab, or home health. This has
caused tremendous problems for hospitals. CMS
has already begun making some modest corrections,
but the key problem is that they are implementing
these inpatient claim cancellations for all DRGs,
not just the 29 DRGs that are affected by the
transfer provision.
CMS staff have indicated that they will be making
additional changes to minimize the burden of this
claims processing change. While CMS has not made
a specific announcement, the following is known:
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CMS
has decided to stop cancelling inpatient claims
for non-transfer provision DRGs. This is a significant
improvement and while the edits will still be
in place for the 29 transfer DRGs, this will
hopefully minimize the impact on cash flow.
They have indicated that this will take from
2-3 weeks to get the system to reflect this
change.
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Hospitals
with significant reductions in payments and
cash flow problems due to the edit should contact
their FI to ask for a payment advance. CMS has
asked the FIs to be flexible with hospitals
on this issue and help hospitals through this
problem. Hospitals that need financial assistance
should initiate their request to the FI as soon
as possible for assistance. If there are problems
getting FIs to advance payments, please forward
that information to OAHHS (Kevin Earls) and
they will work with AHA and CMS on their behalf.
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While
CMS has decided to apply the inpatient claim
cancellations for only the 29 transfer DRGs
at this time, this approach could change. We
should take this opportunity to improve the
coding of the discharge status for the cases
we know receive post-acute care after the hospital
stay.
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