Review of TrailBlazer Health Enterprises, LLC Payments For Inpatient Rehabilitation Facility Claims Billed With Patient Status Code 05 For Calendar Year 2007

摘要

IRFs use patient status codes to designate that a transfer is subject to the transfer regulation. Patient status codes also indicate the type of institution, e.g., inpatient hospitals and skilled nursing facility, to which a beneficiary is transferred. Medicare makes per-diem transfer payments for claims submitted with these codes. IRFs use patient status code 05 to indicate that the beneficiary was discharged/transferred to another type of institution not defined elsewhere. Medicare makes a full case-mix-group payment for claims submitted with this code. During our audit period, calendar year (CY) 2007, CMS contracted with TrailBlazer Health Enterprises, LLC (TrailBlazer) to serve as fiscal intermediary for the states covered by our review. Under this contract, TrailBlazer processed and paid Medicare claims submitted by institutional providers. In August 2007, CMS awarded TrailBlazer the Part A and B Medicare Administrative Contractor contract for Jurisdiction 4. Our review covered 41 Medicare Part A claims totaling 790,093 dollars that were submitted by 17 IRFs in Louisiana, New Mexico, Oklahoma, and Texas, and paid by TrailBlazer during CY 2007.