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Market Trends Impacting Medicare Reimbursements: What You Need to Know

John Garcia
Blog Post06/19/2019
Market Trends Impacting Medicare Reimbursements: What You Need to Know

Healthcare organizations strive to collect in full from government entities. Yet, changing rules and regulations add a layer of complexity that can make this difficult to achieve.

    Below are three trends that may impact your Medicare reimbursement efforts:
  • Medicare-Medicaid Crossover Bad Debt Accounting Classification
    CMS recently updated requirements regarding how to handle Medicare-Medicaid crossover claims, and this change will become effective for cost reporting periods on or after October 1, 2019. With this change, these claims can no longer be written off as a contractual adjustment. Instead, they should be charged to a bad debt expense account.

    Crossover bad debt represents the majority – up to 60% – of all Medicare bad debt.

    What to consider: In advance of this change, hospitals should review current internal processes and assess any necessary accounting adjustments required to ensure revenue isn’t lost.

  • Presumptive Charity Impact on Medicare Bad Debt
    Presumptive charity accounts lack the necessary documentation to be considered reimbursable Medicare bad debt. Some hospitals choose to route certain presumptive charity accounts through their self-pay collection process. As such, the necessary documentation is available to get reimbursed.

    By implementing this change, a hospital system in the Southwest was able to increase its Medicare bad debt reimbursements by $1 million.

    What to consider: Evaluate your presumptive charity and Medicare bad debt processes as well as your charity and collections policies to see how these processes work together to improve recoveries.

  • Uncompensated Care in the 2020 IPPS Proposed Rule
    CMS is proposing use of 2017 reported uncompensated care amounts from worksheet S-10, rather than 2015 amounts. Since uncompensated care is a zero sum game, some hospitals stand to gain while others will lose with this rule change.

    What to consider: It’s important for hospitals to know the impact this rule will have on reimbursements. Hospitals should also check the accuracy of CMS numbers and be encouraged to comment and/or challenge any discrepancies.

Staying up to date on industry changes can help you optimize your Medicare reimbursement strategies.

TransUnion Healthcare’s Medicare Cost Reporting solutions can bolster your government reimbursement efforts to help ensure your earned revenue gets paid.

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