Q&A: Billing for discharge to hospice

Q: When a patient is discharged from an acute care hospital to a hospice program, should this be billed as a discharge or a transfer?

A: A discharge will also be paid as a transfer when the patient is discharged from an IPPS hospital to one of several specific post-acute settings but only when the MS-DRG assigned to that discharge is a qualifying MS-DRG. CMS identifies those MS-DRGs that are Qualifying MS-DRGs in the IPPS final rule for each fiscal year (FY). In FY 2021, 280 out of 767 total MS-DRGs are designated as Qualifying MS-DRGs in Table 5 in the FY 2021 IPPS Final Rule.

Hospice care provided by a hospice program is one of the four post-acute settings that trigger the transfer rules. The hospital should report DSC 50 (Discharged/Transferred to Hospice – Routine or Continuous Home Care) or DSC 51 (Discharged/Transferred to Hospice – General Inpatient Care or Inpatient Respite), as appropriate.

For more information, see "Note from the instructor: Renewed OIG focus on IPPS transfers reported as discharges" by Judith Kares, JD.