In a reversal of fortune, some hospitals will be able to recover the difference between MS-DRG payments and per diem payments in connection with post-acute care transfer (PACT) payment policy errors. MACs recently sent hospitals demand letters for the full MS-DRG payments, which is more money than they owe, compliance professionals and physician advisors said. But now at least one Medicare administrative contractor (MAC) is compromising. Palmetto GBA said Feb. 3 it will recover the MS-DRG payments, but then hospitals can refile claims for the per diems.
“The denials are establishing overpayments for the full [MS-DRG] payment amount. Providers can submit adjustment claims with the appropriate patient discharge code to receive a per diem payment,” Palmetto said on its website.