42 CFR § 409.26 - Transfer agreement hospital services.

(a) Services furnished by an intern or a resident-in-training. Medicare pays for medical services that are furnished by an intern or a resident-in-training (under a hospital teaching program approved in accordance with the provisions of § 409.15 ) as posthospital SNF care, if the intern or resident is in—

(1) A participating hospital with which the SNF has in effect an agreement under § 483.70(j) of this chapter for the transfer of patients and exchange of medical records; or

(2) A hospital that has a swing-bed approval, and is furnishing services to an SNF -level inpatient of that hospital .

(b) Other diagnostic or therapeutic services. Medicare pays for other diagnostic or therapeutic services as posthospital SNF care if they are provided—

(1) By a participating hospital with which the SNF has in effect a transfer agreement as described in paragraph (a)(1) of this section; or

(2) By a hospital or a CAH that has a swing-bed approval, to its own SNF -level inpatient .

Where to Turn for a Safe and Efficient Hospital Transfer

Navigating a hospital transfer can be difficult, but U.S. News can help. Discover where to turn for safe and efficient transfer services and get the best care.

This article is based on reporting that features expert sources.

How to Request a Hospital Transfer

Being stuck in the hospital is no fun, especially when you're dealing with painful conditions or surgeries. However, sometimes you have to deal with a different type of distress, the dreaded feeling that this hospital isn't the right fit for you.

Emergency Department: Doctors, Nurses and Paramedics Push Gurney / Stretcher with Seriously Injured Patient towards the Operating Room.

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If you find yourself second-guessing your situation, a hospital transfer may be the answer.

Why Would You Transfer Hospitals?

There are generally two broad reasons a patient might transfer from one hospital to another:

  • The hospital can’t provide the care the patient needs.
  • The patient or their family is dissatisfied with the quality of care being delivered.

The hospital can't provide the care needed

This scenario – the hospital lacks the necessary or specialized expertise to provide care – is the most common, says Dr. Daniel Eiferman, a critical care surgeon with the Ohio State University Wexner Medical Center in Columbus.

For example, a patient might come in with a trauma injury from a major auto accident. The small hospital they arrive at, however, doesn’t have a trauma center. Or, let's say a patient comes in while having a stroke , but the hospital doesn’t have a stroke center. A third scenario: A patient needs a specific procedure done, such as interventional radiology, but the hospital doesn’t have a radiologist on staff, or the proper equipment to perform the procedure. In these situations, the hospital will transfer the patient to the appropriate facility – more on that later.

In some cases, transfers may occur in advance of a care situation a hospital isn't equipped to handle. For instance, a patient could have complications needing greater medical intervention down the line, says Dr. Naeem Ali, medical director of the Ohio State University Wexner Medical Center University Hospital.

In some cases of labor and delivery, for example, if the doctor has reason to believe that there could be complications, the patient may be transferred to a hospital that has a more robust prenatal or neonatal unit. These units may be better positioned to handle high-risk deliveries and other care needs that can arise as that dynamic situation evolves.

The patient or family requests a transfer

In some rarer instances, a patient or their family may request a transfer if they aren’t happy with the care they’re receiving. Such transfers can become a little murkier and more challenging to achieve.

Ali, who also serves as clinical professor of internal medicine at the Ohio State University College of Medicine, refers to these as “transfers for a second opinion.” In such situations, the receiving hospital will look for affirmative answers to two basic questions before approving the transfer:

  • Does the patient require continued inpatient care?
  • Could the transfer likely change the patient's outcome given their current stage of disease and trajectory?

While transfers related to concerns about the quality of care are often related to a breakdown in communication between provider and patient, Ali says asking about a transfer can spur your current provider to step up how they’re communicating and may be enough to resolve the issues. “More than 90% of the time, this can improve the engagement of the provider team even though a transfer might not be necessary,” he says.

Bringing up a transfer can also help providers and patients get on the same page about the current treatment plan and where they’re headed.

In all cases, facility transfers require the provider to order the transfer request, Ali says.

“Patients or loved ones can facilitate initiating this process by openly asking their providers whether a transfer is necessary and would benefit the patient,” he explains.

But ultimately, it’s up to the hospitals to sort out the transfer and how it will proceed.

How the Transfer Process Works

For whatever reason a transfer is requested, there’s a process for how to organize that move. Eiferman says every hospital has a central call area through which transfer requests are funneled.

When a hospital can't provide the service needed, someone from the hospital will contact other nearby medical centers that do offer that service and ask if they can accept a transfer.

“The accepting hospital then makes a decision about what to do. If they say no, the current hospital will have to continue to search for another hospital,” Eiferman explains.

A hospital may refuse a transfer request if it’s full or otherwise doesn’t have the capacity to care for the patient, he adds. While the transfer is being sorted out, the patient will continue receiving care at the first hospital.

In cases where the patient or a family member wants to initiate a transfer for reasons other than medical necessity, the patient or their advocate should reach out to their hospital case manager or social worker for assistance.

These professionals "are committed to advocating for you and your needs," says Russell Graney, the New York-based founder and CEO of Aidin, an online platform that helps connect providers, patients and payers to improve health care outcomes. "They're experts in the health care system and know how to navigate its many complexities."

Graney adds that you should be sure to "explain your concerns calmly and plainly and know they're there to help you get what you need. Most case managers will have experience supporting patients in tricky situations and will offer counsel and advice given the specifics of your case."

Second Opinions and eConsults

If you're considering a transfer to a new hospital because you’re unhappy with the care you’ve received, Eiferman suggests pursuing another option first: asking for a second opinion.

It’s unlikely that there’s only one of your type of doctor in the hospital, he says, and chances are good another specialist can weigh in on your care plan.

Instead of being an affront to the treating doctor, asking for a second opinion is a sign of a patient who’s invested in their own care. Eiferman says most doctors welcome bringing a colleague into the care discussion and actively support patients asking for a second opinion, which he notes “every patient has a right to.”

If the treating hospital does not have another doctor in that same specialty on-site, you can arrange a telehealth consultation with a doctor at another hospital.

Does Insurance Cover Hospital Transfers?

A key step to any hospital transfer is consulting with your insurance company, says Bob Rees, vice president of Medicare sales and member loyalty with eHealth Inc., a health insurance broker and online resource provider headquartered in Santa Clara, California.

“Specifically, you’ll want to find out if the preferred hospital is in-network with your insurer and whether it will cover ambulance transportation, if that’s necessary," he explains. "While Medicare and all major medical health insurance plans will provide coverage for hospitalization and ambulance services under certain circumstances, the details of coverage can differ significantly and you may face out-of-pocket costs.”

Rees adds that when you talk with your insurance company, you may need to submit a request for pre-authorization to ensure you're covered before the transfer.

“This may involve filing a form and obtaining a letter from your doctor – and possibly medical charts – to demonstrate the medical necessity of the move,” he says.

Keep in mind that transportation to a new hospital may be costly. Medicare, for example, doesn't cover transportation for nonemergency situations, Ali notes. However, "if you are a Medicare member and you have Part B coverage , you will be transported to the nearest appropriate medical center and pay 20% of the cost,” he adds.

In short, make sure you understand your financial responsibilities before you take the plunge on a transfer, and that advice extends to considering other, less tangible costs.

"The biggest cost can be a cost to your health," Graney says. "Ensuring the accepting facility is ready to deliver the needed care is most important, so your care and recovery aren't negatively impacted by your transfer."

Your insurer also may not approve a transfer, Rees notes. He adds, however, that you may be able to appeal a request for pre-authorization that your insurance company has turned down.

If your request is not accepted, Ali recommends asking why. The vast majority of requests are accepted, he says, because they are initiated by the treating physician for reasons of medical necessity. But in some cases, Ali adds, patients are refused a transfer because the hospital determines the change wouldn’t impact the patient’s outcome or the risks of moving the patient could worsen their condition.

The bottom line is that patients can ask their preferred hospital to admit them, but the hospital doesn't have to agree, especially if it has nothing unique to offer – such as a specialized burn unit for a severely burned patient, for instance, or the capability to undertake advanced cardiac surgery when needed.

Selecting the Right Hospital in Non-Emergent Situations

When it comes to selecting a hospital for care, if you have the luxury of time, Eiferman recommends selecting a hospital that handles a high volume of patients with the same condition as you.

“There are multiple studies in the literature about how patients have better outcomes at high-volume centers for high-risk procedures," he explains. "If you need something that is high risk or not commonly done in your hospital, I think it’s very reasonable to say that you’d like to be transferred to a high-volume hospital.”

Not only does practice make perfect, but advanced care centers that deal frequently with a specific type of procedure or care plan have the appropriate staff and equipment, such as physical and occupational therapists, specialized nursing staff and the latest technology.

As the patient, you can ask if the procedure you’re being offered is something that’s performed commonly at the hospital that’s treating you. If the hospital doesn’t deal with a high volume of that procedure, that's an opportunity to ask for a transfer or a consult with a physician who does more of those procedures, Eiferman says.

Transitioning Care

Moving from one facility to another – or even between doctors – is not unusual.

“Transferring care isn't only for when something isn't going right," Graney points out. "Almost every health care journey includes transitions from one provider to the next. Hospital patients, for example, often need follow-up care after surgery or a serious illness.”

Moving you safely and securely to this next level of care is "one of the essential services your health care team should provide," he adds. 

What to Pack in Your Hospital Bag

Senior woman packing her luggage in bedroom.

The U.S. News Health team delivers accurate information about health, nutrition and fitness, as well as in-depth medical condition guides. All of our stories rely on multiple, independent sources and experts in the field, such as medical doctors and licensed nutritionists. To learn more about how we keep our content accurate and trustworthy, read our  editorial guidelines .

Ali is medical director of the Ohio State University Wexner Medical Center University Hospital and clinical professor of internal medicine at the Ohio State University College of Medicine in Columbus.

Eiferman is a critical care surgeon with the Ohio State University Wexner Medical Center in Columbus.

Graney is founder and CEO of Aidin, an online platform that helps connect providers, patients and payers to improve health care outcomes. He is based in New York City.

Rees is chief sales officer with eHealth Inc., a health insurance broker and online resource provider headquartered in Santa Clara, California.

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ASC Turnarounds: Ideas to Improve Performance

Cms eliminates asc hospital transfer agreement requirement in new rule.

A new CMS rule will make it easier for ASCs to run efficient and effective operations.

CMS released its final rule on Sept. 25: "Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction," which is expected to eliminate unnecessary or obsolete compliance requirements for healthcare providers. The agency estimates that changes could save $843 million within the first year of implementation.

ASCA has spent several years working with CMS to address concerns related to the provisions of this final rule. "We are pleased to see this support for patient access to ASCs and look forward to working with CMS on other initiatives that will enable Medicare patients to take fuller advantage of top-quality, lower cost care ASCs deliver," said Kara Newbury, ASCA Director of Government & Regulatory Counsel.

The new rule takes effect in 60 days.

As a result of the new rule:

1. ASCs won't have to have a written transfer agreement or hospital planning privileges for all physicians. Centers will need to provide hospitals with a document that includes information about their operation and their patient population.

2. CMS is working on a final proposal to require ASCs to create a policy for identifying patients that need a medical history and physical examination before surgery, instead of requiring this from all patients 30 days prior to the procedure. ASCA spells out the potential information CMS would require about the patient's history and physical examination here .

3. ASCs will be allowed to review their emergency preparedness plan every two years instead of every year, and they won't need to contact local, tribal, regional, state and federal emergency preparedness officials as part of their plan. The training for emergency preparedness is now only required every two years as well, instead of annually.

"This rule makes it easier for ambulatory surgery centers to remain efficient and affordable providers of outpatient surgery without compromising their commitment to patient safety," said ASCA CEO William Prentice.

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Table of Contents

Agreement template bundle, 5 steps to make patient transfer agreement, 6+ patient transfer agreement templates, 1. sample patient transfer agreement template, 2. patient transfer agreement example, 3. generic patient transfer agreement format, 4. patient transfer agreement template, 5. standard patient transfer agreement example, 6. patient transfer agreement in pdf, 7. simple patient transfer agreement format.

Patient transfer agreements are prepared and signed between the two parties to shift the patient immediately to the best care center. This agreement is done when a medical institution witnesses that they are not being able to make any improvement in the patient’s condition. We have designed several Patient transfer agreement template that you can choose from to frame your agreement. Have a look at them!

transfer agreement between hospitals

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Step 1: Hospital Details

Step 2: matter description, step 3: medical records, step 4: transferring facility, step 5: signatures.

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IMAGES

  1. 6+ Patient Transfer Agreement Templates

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  2. 9+ Medical Consultant Agreement Templates

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  3. Fillable Online Community-Wide Transfer Agreement between Hospitals

    transfer agreement between hospitals

  4. Products > Documentation > Hospitals & Clinics > Admission, Transfer

    transfer agreement between hospitals

  5. 6+ Patient Transfer Agreement Templates

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  6. Free 10 Transfer Agreement Forms In Pdf Ms Word Excel

    transfer agreement between hospitals

COMMENTS

  1. PDF Transfer Agreement Example

    Transfer Agreement Example. (e.g., burn, traumatic brain injuries, spinal cord injuries, pediatrics); and whereas the parties specifically wish to facilitate: (a) the timely transfer of patients and information necessary or useful in the care and treatment of trauma patients transferred, (b) the continuity of the care and treatment appropriate ...

  2. PDF TRANSFER AGREEMENT BETWEEN

    10. This agreement shall be in effect from the date both parties sign. It may be terminated by either facility upon 30 days written notice, with copies sent to the district office of the Licensing and Certification Division, having jurisdiction for your facility. 11. This agreement shall be maintained in the facilities' files.

  3. PDF Patient Transfer Agreement Between <Transfering Provider> and

    Attachment 05 - Patient Transfer Agreement C. The flow of patient information: 1. TRANSFEROR will provide information and education related to antepartum and postpartum care for patient enrolled in Medi-Cal programs including CPSP and eligible for pregnancy related services.

  4. APPENDIX S Sample Transfer Agreement

    Inter-Hospital Transfer Agreement 3 DWT 13380588v1 0046243 -000005 (e) Transfer of Patient Records. The Transferring Hospital will f orward (with the patient or by electronic means) copies of those portionsof the patient's medical record that are relevant to the transfer and continued care of the patient, including

  5. Appropriate Interfacility Patient Transfer

    Agreement to accept the patient in transfer should be obtained from a physician or responsible individual at the receiving hospital in advance of transfer. When a patient requires a higher level of care other than that provided or available at the transferring facility, a receiving facility with the capability and capacity to provide a higher ...

  6. PDF CMS Manual System

    40.2.4 - IPPS Transfers Between Hospitals (Rev. 87, 02-06-04) A3-3610.5, HO-415.8 A transfer between acute inpatient hospitals occurs when a patient is admitted to a hospital and is subsequently transferred to another for additional treatment once the patient's condition has stabilized or a diagnosis established. The following procedures apply.

  7. When an ASC Dials 911: The Basics of Hospital Transfer Agreements

    Texas. Utah. Ohio's regulation is representative of the first group, stating that an ASC "shall have a written transfer agreement with a hospital for transfer of patients in the event of medical complications, emergency situations, and for other needs as they arise." Under the Texas regulation, on the other hand, an ASC "shall have a written ...

  8. PDF Patient Transfer and Return Agreement

    Receiving Facility, or on the basis of an existing Transfer and Shared Services Agreement between Transferring Facility and Children's. Transferring facility name: Authorized hospital representative signature: Please print name: Title: Date: PLEASE RETURN COMPLETED FORM TO FAX NUMBER: 404-785-9186 . Patient Information

  9. PDF TRANSFER & REPATRIATION AGREEMENT Date of Transfer: Referring Physician

    This Agreement shall confirm the Referring Facility agrees to accept the patient, in return transfer, upon request of UCIMC to do so. 5. The Referring Facility will accept patient for transfer back to their facility whether or not the patient still meets inpatient criteria for the purpose of ongoing acute care or for post‐

  10. 42 CFR § 409.26

    (1) A participating hospital with which the SNF has in effect an agreement under § 483.70(j) of this chapter for the transfer of patients and exchange of medical records; or (2) A hospital that has a swing-bed approval, and is furnishing services to an SNF-level inpatient of that hospital. (b) Other diagnostic or therapeutic services.

  11. PDF Transfer Agreement between a Hospital and a Related Health Facility in

    The purpose of this agreement is to provide health care most suited to the individual (patients/residents) needs. This agreement shall operate to promote optimum use of the acute care facilities of general hospital and of the post-acute care services of the related health facility. This agreement shall comply with appropriate requirements of ...

  12. PDF CENTRAL CALIFORNIA EMERGENCY MEDICAL SERVICES

    Subject Guidelines for Transfer Agreements Between Acute Care Hospitals References Effective 11/01/90 I. POLICY All patient transfers between acute care hospitals will be conducted in a manner which provides for the medical needs of the patient. These transfers will be in accordance with written transfer agreements between participating hospitals.

  13. How to Request a Hospital Transfer

    Navigating a hospital transfer can be difficult, but U.S. News can help. Discover where to turn for safe and efficient transfer services and get the best care.

  14. CMS releases guidance for hospitals implementing interoperability rule

    The Centers for Medicare & Medicaid Services today released interpretive guidance on hospital admission, discharge, and transfer notification requirements outlined in its May 2020 final rule on interoperability and patient access, which includes Medicare conditions of participation for hospitals, psychiatric hospitals and critical access hospitals. . Due to the COVID-19 public health emergency ...

  15. PDF Patient Transfer Agreement

    This Agreement shall apply to transfers between ____________hospital location and referring Hospital. The need for transfer of a patient from one Institution to another shall be determined by the patient's attending physician who will contact the receiving hospital regarding the need for transfer. The receiving Institution shall confirm its ...

  16. Improving Hospital Transfers: A Step Toward Equitable, Patient-Centered

    Approximately 5.5 million ED patients and inpatients are transferred between hospitals each year. Unfortunately, these transfers are taking longer and longer to happen; from 2010 to 2019, the ...

  17. CMS Eases ASC Regulations Concerning Patient Transfers, Examinations

    CMS believes that the change to the hospital transfer agreement requirements is appropriate due to "the small burden of transfers" and "the burden ASCs incur when faced with local hospital competition issues." CMS noted that, under the new regulations, ASCs will not be "precluded from obtaining hospital transfer agreements or hospital ...

  18. EMTALA and Patient Transfers

    The transfer of the patient to another hospital must follow detailed guidelines set by EMTALA. An appropriate transfer, as stated by Smith in "EMTALA Basics: What Medical Professionals Need to Know," is defined as: The transferring hospital provides medical treatment to minimize the risks to the individual's or unborn child's health. ...

  19. CMS eliminates ASC hospital transfer agreement requirement in new rule

    The new rule takes effect in 60 days. As a result of the new rule: 1. ASCs won't have to have a written transfer agreement or hospital planning privileges for all physicians. Centers will need to provide hospitals with a document that includes information about their operation and their patient population. 2.

  20. PDF TRANSFER AGREEMENT

    TRANSFER AGREEMENT. 1. <Hospital Initials> will accept all of ASC patients in need of medical care offered at a full services general acute hospital upon the request of ASC and the Referring Physician, the physician responsible for the patient's care at ASC, depending on bed and staff availability and patient need.

  21. PDF Texas EMTALA

    This transfer policy shall apply to patient transfers when there is no patient transfer agreement between hospitals and the transfer is between acute care hospitals licensed under the Texas Health and Safety Code, Chapters 241 and 577, as well as to psychiatric or mental hospitals, and other hospitals exempt from licensing.

  22. PDF Medicare Services (DHHS) Skilled Nursing Facility Manual ...

    agreement with one or more participating hospitals (see § 205) providing for the transfer of patients between the hospital and the SNF, and for the interchange of medical and other information. If an otherwise qualified SNF has attempted in good faith, but without success, to enter into a transfer agreement, this requirement may be waived by ...

  23. 6+ Patient Transfer Agreement Templates

    The patient transfer agreement should begin by specifying the details of the hospitals. It means the hospital the patient was admitted in and the one in which he or she is being transferred to. Step 2: Matter Description. The reason to make such a transfer needs to be specified in the description. The facility the current hospital is lacking in ...

  24. 23000, Interfacility Transfers

    Revision 24-1; Effective March 1, 2024This section outlines the processes for transfers between state supported living centers (SSLCs) and state hospitals.23100 State Hospital to SSLCRevision 24-1; Effective March 1, 202426 TAC, Section 904.79A person receiving inpatient services from a state hospital, also known as a state psychiatric hospital, may be transferred to a state supported living ...