Humana Automates Inpatient Transfer Adjustments for Select Claims

Short-term, acute-care hospitals are encouraged to take note of the following transfer adjustment guidelines for select Medicare Advantage and commercial contracts:

While Humana has followed industry-standard practices in regard to transfer adjustments on inpatient claims, the process for applying these adjustments to non-Prospective Payment System (PPS) inpatient claims has been manual. Humana will now be automating this process for commercial and Medicare Advantage non-PPS inpatient claims if transfer language exists in the provider contracts. Claims submitted with discharge status codes 02, 03, 05, 06, 62, 63, 65 and 66, and additional codes as may be defined by the Centers for Medicare & Medicaid Services (CMS) in the future, indicate that the patient was transferred to another facility and, therefore, may qualify for a transfer payment adjustment. For non-PPS provider contracts that do not include transfer language, the transfer adjustment will not be applicable.