Why is a length of stay review performed and a number of days certified for DRG-reimbursed hospitalizations reviewed retrospectively?
The certified length of stay for a DRG-reimbursed claim may affect the claim payment. a) The certified length of stay and the associated covered charges can affect the determination of a cost/day outlier. b) If the provider is eligible for other add-on payments such as Disproportionate Share, MHVA, or MPA the certified length of stay affects these add-on payments since they are per day add-ons for the approved covered days. c) The total covered charges for the certified length of stay is also used in determining the base payment for claims that are paid at the lesser of either the Departments calculated payment, or the providers covered charges.
