Transfer DRG Review

A Transfer DRG refers to a DRG classification and payment adjustment that applies when a patient is transferred between hospitals before completing the full expected length of stay, potentially reducing payment for the initial hospital.

It ensures accurate DRG assignment and appropriate reimbursement by reviewing whether the patient’s diagnosis and treatment align with the assigned DRG and Medicare's transfer payment rules.

By identifying underpayments or miscoded DRGs, hospitals can correct errors, file appeals, and ensure they are fully reimbursed for the care provided during a transfer episode.

Clinical validation confirms that the documented clinical findings support the assigned DRG, helping maintain documentation integrity and prevent compliance issues.

Yes, Transfer DRG reviews often uncover gaps or inconsistencies in documentation, which can guide improvement efforts for better accuracy in future coding and billing.

The organization may need to file a corrected claim or an appeal with the payer to ensure fair reimbursement based on the accurate DRG and clinical data.

Transfer DRG review services are designed to follow all Medicare rules and guidelines, helping healthcare providers remain compliant and audit-ready.