Review of Hospital Compliance with Medicare's Transfer Policy with the Resumption of Home Health Services & Other Information on Patient Discharge Status Codes

The Office of Inspector General (OIG) has conducted several reviews identifying Medicare overpayments to hospitals that didn’t comply with Medicare’s post-acute care transfer policy. The OIG review, August 2020 Report No. A-04-18-04067, identifies Medicare overpayments to hospitals that didn’t comply with Medicare's post-acute-care transfer policy (transfer policy). In these instances, to ensure proper coding of the patient discharge status, hospitals should use condition codes 42 and 43. This article addresses these OIG reviews and provides guidance on the proper coding of patient status codes and the use of condition codes 42 and 43.