Code of Maine Rules
90 - INDEPENDENT AGENCIES
351 - WORKERS' COMPENSATION BOARD
Chapter 5 - MEDICAL FEES; REIMBURSEMENT LEVELS; REPORTING REQUIREMENTS
Sec2 351-5-3 - INPATIENT FACILITY FEES
Subsection 351-5-3-09 - FACILITY TRANSFERS
Current through 2024-38, September 18, 2024
The following applies to facility transfers when a patient is transferred for continuation of medical treatment between two hospitals:
1. A hospital transferring a patient is paid as follows: The MS-DRG reimbursement amount is divided by the number of days duration listed for the DRG; the resultant per diem amount is then multiplied by two for the first day of stay at the transferring hospital; the per diem amount is multiplied by one for each subsequent day of stay at the transferring hospital; and the amounts for each day of stay at the transferring hospital are totaled. If the result is greater than the MS-DRG reimbursement amount, the transferring hospital is paid the MS-DRG reimbursement amount. Associated outliers and add-ons are then added to the payment.
2. A hospital discharging a patient is paid the full MS-DRG payment plus any appropriate outliers and add-ons.
3. Facility transfers do not include costs related to transportation of a patient to obtain medical care. Costs related to transportation are payable separately.
