Discharge Disposition and Transfer Rules
Reporting and Auditing Strategies to Avoid Compliance Risk
Product Description:
Audio Conference on CD or Audio On-Demand
Sponsored by Briefings on Coding Compliance Strategies and Case Management Monthly
A program for case management and discharge planning professionals
presented on October 28, 2009
Hospitals don't always receive the full DRG payment for certain inpatient stays, primarily where the patient is transferred to another acute hospital or discharged to certain post-acute settings. This often happens following an unusually short stay in the discharging hospital.
In many of these instances, accurate and complete documentation may not be available, making it harder to select the right discharge code. Communication across department lines is critical for hospitals to identify and report those inpatient stays that are subject to the transfer rules.
During this 90-minute, intermediate-level, audio conference, our speakers explain how to identify and report to CMS those inpatient stays that are subject to the transfer rules prior to submitting the original inpatient claims. This will help ensure you receive appropriate payment, prevent having to resubmit adjusted claims, and avoid risk and penalties during audits and other enforcement activities.
LEARNING OBJECTIVES
At the conclusion of this audio conference, you will be able to:- Identify and report inpatient stays that are subject to payment under the acute or post-acute transfer rules, including the qualifying DRGs, discharge status codes, settings, and timing that trigger the applicability of the post-acute transfer rules
- Integrate documentation and communication of discharge status information into related processes so that the hospital can report appropriate discharge status codes on related inpatient claims
- Calculate the DRG payment for specific acute and post-acute transfers, including those post-acute transfers that are referred to as "special pays"
- Explain potential problem areas that require follow up after discharge to ensure proper payment
- Describe areas of current regulatory scrutiny and related financial and compliance risk
TAKE A LOOK AT THE AGENDA:
- Identifying inpatient stays that may be subject to payment under the acute or post-acute transfer rules
- Same day transfers to acute care hospitals
- Post-acute transfers
- Qualifying DRGs
- Settings and timing for application of these transfer rules
- Hospitals' responsibility to report appropriate discharge status codes
- Processing information, including preparation and submission of transfer claims-who's responsible and how to communicate
- Calculating the DRG payment
- Payment for most acute and post-acute transfers
- "Special pays"
- Current regulatory focus on hospital compliance with the transfer rules
- CMS
- OIG
- RACs
- Following up to make sure you got it right
- Auditing documentation, discharge status code assignment, and reporting findings
- Checking for changes to the original discharge plan
- What you should be doing to prevent errors
A question and answer session follows the presentation.
MATERIALS
In addition to the expertise and advice presented during this audio conference, you'll also receive a slide presentation of the program materials and the following:- Transfer checklist
- DRG tables
- Flowchart of DRG transfer payment calculation (both general and "special pays")
- Outlier payment calculation example
- Summary of current auditing/enforcement activity and key links to official sources of information
- Statistics from RAC demonstrations
These materials are provided via e-mail with PDF links.
MEET THE SPEAKERS
Judith Kares, JD, CPC, is a practicing attorney and compliance consultant with twenty-four years of experience representing hospitals, third-party payers and other health care clients in the areas of health care contracting and regulatory compliance. Kares also serves currently as an instructor for HCPro's Medicare Boot Camp® - Hospital Version.Debbie Mackaman, RHIA, CHCO, is an instructor for HCPro's Medicare Boot Camp®-Hospital Version. She has more than 18 years of experience in the healthcare industry, including both inpatient and outpatient prospective payment systems and critical access hospital coding and reimbursement issues.
CONTINUING EDUCATION
This program has prior approval of the American Academy of Professional Coders for 1.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the Academy of the program, content or the program sponsor. Credits expire 10/28/10.This program has been approved for 1 continuing education unit for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Credits expire 10/28/10.
WHO SHOULD LISTEN?
Discharge planners, case managers, HIM directors and managers, coders, utilization review, CFO, finance managers, billing office managers, and billers.AUDIO ON-DEMAND
In addition to the regular purchase options for HCPro audio conferences, we are pleased to offer another option, audio on-demand. Audio on-demand allows you to download the program and play it back at your convenience through your computer or MP3 player. Purchase a CD or audio on-demand of the program and listen when you can. It's also a perfect training tool for new staff or as a refresher for veteran staff.Product Types : Departments :
