OAR 410-125-0400
Discharge


(1)

A discharge from a hospital is the formal release of a patient to home, to another facility such as an intermediate care facility or nursing home, to a home health care agency, or to another provider of health care services.

(2)

For services beginning January 1, 1993, and later, the transfer of a patient from acute care to a distinct part physical rehabilitation unit (i.e., a unit exempt from the Medicare Prospective Payment System) within the same hospital will be considered a discharge. The admission to the rehabilitation unit is billed separately. All other transfers occurring within a hospital, including transfers to Medicare PPS-exempt psychiatric units, will not be considered discharges, and all charges for services must be submitted on a single UB-04 billing for the admission.

(3)

Transfer from a hospital occurs when an individual is formally released to another acute care hospital, to a long-term acute care hospital, to a skilled nursing facility, or an intermediate care facility. When a physician sends a patient directly to another hospital for further inpatient care, the discharge should be billed as a transfer, regardless of the mode of transportation.

(4)

When the Division receives claims from two hospitals for the same patient, and the date of discharge from one hospital is the same as the date of admission to the other, the Division will assume that a transfer has occurred. The Division will change the discharge status code on the first claim to 02 (Transferred to Another Acute Care Facility), automatically generating an adjustment if the claim has already been adjudicated, unless discharge status on the claim is already 02 (Transfer) or 07 (Discharge AMA). If it is believed that the Division made an error in assigning Discharge Status code 02 to a claim, the hospital may submit an Adjustment Request along with supporting documentation from the medical record.

(5)

A transfer between units within a hospital is not a transfer for billing purposes, except in the case of transfers to distinct part physical rehabilitation units. Note that transfers in the other direction from rehabilitative care to acute care are not considered discharges from the rehabilitation unit unless the stay in the acute setting exceeds seven days. Stays of seven days or less in the acute care setting may not be billed separately.

(6)

Some transfers, including transfers to distinct part rehabilitation units, require prior authorization.
410‑125‑0000
Determining When the Patient Has Medical Assistance
410‑125‑0020
Retroactive Eligibility
410‑125‑0030
Hospital Hold
410‑125‑0040
Title XIX/Title XXI Clients
410‑125‑0041
Non-Title XIX/XXI Clients
410‑125‑0045
Coverage and Limitations
410‑125‑0050
Client Copayments
410‑125‑0080
Inpatient Services
410‑125‑0085
Outpatient Services
410‑125‑0086
Prior Authorization for FCHP/MHO Clients
410‑125‑0090
Inpatient Rate Calculations — Type A, Type B, and Critical Access Oregon Hospitals
410‑125‑0095
Hospitals Providing Specialized Inpatient Services
410‑125‑0101
Hospital-Based Nursing Facilities and Medicaid Swing Beds
410‑125‑0102
Medically Needy Clients
410‑125‑0103
Medicare Clients
410‑125‑0115
Non-Contiguous Area Out-of-State Hospitals — Effective for services rendered on or after October 1, 2003
410‑125‑0120
Transportation To and From Medical Services
410‑125‑0121
Contiguous Area Out-of-State Hospitals — Effective for services rendered on or after October 1, 2003
410‑125‑0124
Retroactive Authorization
410‑125‑0125
Free-Standing Inpatient Psychiatric Facilities
410‑125‑0140
Prior Authorization Does Not Guarantee Payment
410‑125‑0141
DRG Rate Methodology
410‑125‑0142
Graduate Medical Education Reimbursement for Public Teaching Hospitals
410‑125‑0146
Supplemental Reimbursement for Public Academic Teaching University Medical Practitioners
410‑125‑0150
Disproportionate Share
410‑125‑0155
Upper Limits on Payment of Hospital Claims
410‑125‑0162
Hospital Transformation Performance Program
410‑125‑0165
Transfers and Reimbursement
410‑125‑0170
Death Occurring on Day of Admission
410‑125‑0175
Hospitals Providing Specialized Outpatient Services
410‑125‑0180
Public Rates
410‑125‑0181
Non-Contiguous and Contiguous Area Out-of-State Hospitals — Outpatient Services
410‑125‑0190
Outpatient Rate Calculations — Type A, Type B, and Critical Access Oregon Hospitals
410‑125‑0195
Outpatient Services In-State DRG Hospitals
410‑125‑0200
Time Limitation for Submission of Claims
410‑125‑0201
Independent ESRD Facilities
410‑125‑0210
Third Party Resources and Reimbursement
410‑125‑0220
Services Billed on the Electronic 837I or on the Paper UB-04 and Other Claim Forms
410‑125‑0221
Payment in Full
410‑125‑0230
Qualified Directed Payments
410‑125‑0360
Definitions and Billing Requirements
410‑125‑0400
Discharge
410‑125‑0401
Definitions: Emergent, Urgent, and Elective Admissions
410‑125‑0410
Readmission
410‑125‑0450
Provider Preventable Conditions
410‑125‑0550
X-Ray or EKG Procedures Furnished in Emergency Room
410‑125‑0600
Non-Contiguous Out-of-State Hospital Services
410‑125‑0620
Special Reports and Exams and Medical Records
410‑125‑0640
Third Party Payers — Other Resources, Client Responsibility and Liability
410‑125‑0641
Medicare
410‑125‑0720
Adjustment Requests
410‑125‑1020
Filing of Cost Statement
410‑125‑1040
Accounting and Record Keeping
410‑125‑1060
Fiscal Audits
410‑125‑1070
Type A and Type B Hospitals
410‑125‑1080
Documentation
410‑125‑2000
Access to Records
410‑125‑2020
Post Payment Review
410‑125‑2030
Recovery of Payments
410‑125‑2040
Provider Appeals — Administrative Review
410‑125‑2060
Provider Appeals — Hearing Request
410‑125‑2080
Administrative Errors
Last Updated

Jun. 8, 2021

Rule 410-125-0400’s source at or​.us