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April 5, 2024

CERT Error: Patient Discharge Status Codes

The Comprehensive Error Rate Testing (CERT) contractor continues to identify claim errors related to the patient discharge status code billed at the conclusion of a health care facility encounter. Specifically, the code reported on the claim does not match the patient’s location or the type of care received after discharge or transfer according to the documentation submitted for review and/or the Common Working File (CWF).

Patient discharge status codes identify where a patient is at the conclusion of a health care facility encounter or at the end of a billing cycle. You are responsible for coding the discharge bill based on the discharge plan for the patient, and if you later learn that the patient received post-acute care, the hospital should submit an adjustment bill to correct the discharge status code following Medicare’s claim adjustment criteria located in the CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 1External PDF, Section 130.1.1 and Chapter 34External PDF.


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