April 5, 2018
We’ll be adjusting how patient transfers from any acute care hospital to another acute care facility will be reimbursed, effective for dates of service on or after July 5, 2018. These short hospital stays will be reimbursed a calculated per diem, rather than paid a full DRG-calculated rate for the short stay.
When an inpatient is transferred to another acute care hospital for additional or continued care not available in the initial hospital, we’ll handle reimbursement in the following way:
If the transferring hospital is contractually reimbursed on a DRG payment methodology, we’ll reimburse the transferring facility a graduated per diem rate. This per diem rate will be based on the DRG case rate for the services rendered, and it won’t exceed the full DRG rate for the patient’s stay in the transferring hospital.
The per diem rate paid to the transferring facility will be calculated in the following way, similar to CMS calculations for the same scenario. The per diem rate will be based on the full rate of the DRG, divided by the geometric mean length of stay for the DRG, multiplied by the number of days spent in the initial hospital.
The payment to the transferring facility won’t exceed what would have been allowed under the full DRG case rate for the stay.
Check the published Payment Policy for the full details on how the per diem will be calculated.