Hospital Discharge Status Assistance

Providers are required to bill the appropriate discharge status code. Overpayment or underpayment of Medicare claims may result when facilities incorrectly bill a discharge status code. Office of Inspector General (OIG) reviews identified overpayments to hospitals that did not comply with post-acute care transfer policy.

For example, the discharging facility uses Patient Discharge Status code 03 (discharge to a skilled nursing facility); however, reviewing the submitted documentation shows the beneficiary was discharged to a rehabilitation facility, Patient Discharge Status code 62. This resulted in incorrect payment to the discharging hospital, and the admitting facility was not able to be paid due to the incorrect billing of the discharge facility.

To assist in the reduction of claims returned to provider (RTP), rejections, denials and claim recoupment, facilities have an opportunity to implement an added element to discharge planning.

  1. Call the receiving facility, beneficiary, or representative after discharge to confirm the beneficiary safely arrived at the discharged location.
  2. Make a notation in the beneficiary chart of the location. This will assist the coder, or biller.
  3. Prior to billing review internal medical records, or electronic internal software to choose the appropriate beneficiary’s discharge status.
    1. Did the patient transfer to another facility?
    2. Did the patient go home?

Improper payments due to incorrect billing of Discharge Status Codes are costly and are easily preventable.



            Last Updated Thu, 05 Nov 2020 20:38:23 +0000