CMS Pub. 100-04, ch. 3, § 20.1.2.4

A. Transfers Between IPPS Hospitals

For transfers between IPPS hospitals, the transferring hospital is paid based upon a per diem

rate. The transferring hospital may be paid a cost outlier payment. The outlier threshold for

the transferring hospital is equal to the outlier threshold for non-transfer cases, divided by the

geometric mean length of stay for the DRG, multiplied by a number equal to the length of

stay for the case plus one day.

The payment to the final discharging hospital is made at the full prospective payment rate.

The outlier threshold and payment are calculated the same as any other discharge without a

transfer. For further information on transfers between IPPS hospitals, see §40.2.4 part A of

this manual.

B. - Transfers from an IPPS Hospital to Hospitals or Units Excluded from IPPS that do

not Fall within a DRG that is Subject to the Postacute Care Transfer Policy

For transfers from an IPPS hospital to a hospital or unit excluded from IPPS with a DRG that

is not subject to the postacute care transfer policy, the transferring hospital is paid the full

IPPS rate. The transferring hospital may be paid a cost outlier payment. The outlier

threshold and payment are calculated the same as any other discharge without a transfer.

The payment to the final discharging hospital or unit is made at the rate of its respective

payment system. For further information on transfers from an IPPS hospital to hospitals or

units excluded from IPPS that do not fall within a DRG that is subject to the postacute care

transfer policy, see §40.2.4 part B of this manual.

C. - Transfers from an IPPS Hospital to Hospitals or Units Excluded from IPPS that

Fall within a DRG that is Subject to the Postacute Care Transfer Policy

For transfers from an IPPS hospital to a hospital or unit excluded from IPPS with a DRG that

is subject to the postacute care transfer policy, the transferring hospital is paid based upon a

per diem rate. The transferring hospital may be paid a cost outlier payment. In general, the

outlier threshold for the transferring hospital is equal to the outlier threshold for non-transfer

cases, divided by the geometric mean length of stay for the DRG, multiplied by a number

equal to the length of stay for the case plus one day. If a discharge is assigned to a special

pay DRG subject to the post acute care transfer policy the outlier threshold is equal to the

fixed-loss cost outlier threshold for non-transfer cases, divided by the geometric mean length

of stay for the DRG, multiplied by 0.5 plus the product of the 0.5 multiplied by a number

equal to the length of stay plus one day multiplied by 0.5.

The payment to the final discharging hospital or unit is made at the rate of its respective

payment system. For further information on transfers from an IPPS hospital to hospitals or

units excluded from IPPS that fall within a DRG subject to the postacute care transfer policy,

see §40.2.4 part C and D.