The CMS used its 2004 inpatient regulations to expand a controversial policy governing patient transfers, but the regulations also contain changes beneficial to providers, including a lower outlier threshold than previously proposed and a full inflation update. The regulations, published today and effective Oct. 1, bring to 29 from 10 the number of DRGs subject to the transfer policy. Hospitals complain that the policy unfairly costs them money because under it the CMS pays per diem rates instead of the DRG rate for patients discharged to post-acute facilities before the average length of stay for the DRG. Meanwhile, after proposing a $50,645 outlier threshold -- the amount costs would have to exceed the DRG rate for hospitals to receive additional payments -- the CMS set a threshold of $31,000, lower than the current threshold of $33,560. And, unless Congress changes the 2004 update, hospitals would receive a 3.4% increase in payments, matching inflation. Read the regulations. -- by Jeff Tieman
CMS' 2004 inpatient regulations pack surprises
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