Ariz. Admin. Code § R9-22-712.67 - DRG Reimbursement: Transfers
A. For purposes of this Section a "transfer"
means the transfer of a member from a hospital to a short-term general hospital
for inpatient care, a designated cancer center, children's hospital, or a
critical access hospital except when a member is moved for the purpose of
receiving sub-acute services.
B.
Designated cancer center or children's hospitals are those hospitals identified
as such in the UB-04 billing manual published by the National Uniform Billing
Committee.
C. The hospital the
member is transferred from shall be reimbursed either the initial DRG base
payment or the transfer DRG base payment, whichever is less.
D. The transfer DRG base payment is an amount
equal to the initial DRG base payment, as determined after making any provider
or service policy adjustors, divided by the DRG National Average length of stay
for the DRG code multiplied by the sum of one plus the length of
stay.
E. The hospital the member is
transferred to shall be reimbursed under the DRG payment methodology without a
reduction due to the transfer.
F.
Unadjusted DRG base payment. The unadjusted DRG base payment is either the
initial DRG base payment, as determined after making any provider or service
policy adjustors, or the transfer DRG base payment, whichever is
less.
Notes
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