MLN Matters Number: MM7141

Related Change Request (CR) #: 7141
Related CR Release Date: November 12, 2010
Effective Date: October 1, 2010
Related CR Transmittal #: R807OTN
Implementation Date: April 4, 2011

[The following is copied directly from this MLN Matters posting by CMS.]

Expansion of Inpatient Prospective Payment System (IPPS) Transfer Policy
to Include Critical Access Hospitals (CAHs) and Non-Participating Hospitals

Provider Types Affected

This article is for inpatient acute care prospective payment system hospitals that bill Medicare fiscal intermediaries (FIs) or Medicare Administrative Contractors
(MACs) for services provided to Medicare beneficiaries.

Provider Action Needed

Effective October 1, 2010, the transfer regulations at 42 CFR 412.40(b) (see http://edocket.access.gpo.gov/cfr_2004/octqtr/pdf/42cfr412.4.pdf) include transfers to Crtitcal Access Hospitals (CAHs) and nonparticipating hospitals. Make sure your billing staff is aware of these changes.

 Background

A discharge of an acute hospital inpatient is considered to be a transfer for purposes of payment if the discharge is made from the acute hospital to the care
of another inpatient prospective payment system (IPPS) hospital. This policy is also in effect for patients who leave against medical advice, known as LAMAs. For patients who are admitted to another IPPS hospital on the same day they leave an IPPS hospital, the “transferring” hospital will be subject to the payment outlined by the transfer policy. Only IPPS hospitals are subject to this transfer policy prior to
October 1, 2010.
Effective October 1, 2010, the transfer regulations at 42 CFR 412.4(b) include IPPS hospital transfers to a Critical Access Hospital (CAH) and a transfer to a nonparticipating hospital.

Additional Information

The official instruction, CR 7141 issued to your FI or MAC regarding this change may be viewed at http://www.cms.gov/Transmittals/downloads/R807OTN.pdf on the Centers for Medicare & Medicaid (CMS) website.