An automated Recovery Auditor review of discharge status codes identified improper payments, according to the Medicare Quarterly Compliance Newsletter. However, CMS did not report the prevalence of the errors.
The Recover Auditor reviewed all claims with discharge status code 02 (discharged/transferred to a short-term general hospital for inpatient care). It also reviewed selected MS-DRGs for the following discharge status codes:
- 03, discharged/transferred to skilled nursing facility with Medicare certification in anticipation of covered skilled care
- 05, discharged/transferred to designated cancer center or children’s hospital
- 06, discharged/transferred to home under care of organized home health service organization in anticipation of covered skilled care
- 62, discharged/transferred to an inpatient rehabilitation facility including distinct part units of a hospital
- 63, discharged/transferred to long-term care hospital
- 65, discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital
CMS suggested hospitals review MLN Matters® SE0801, Clarification of Patient Discharge Status Codes and Hospital Transfer Policies, to help determine the right discharge status code to use.