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Reducing the Adverse Impact of Medicare Audits: The Importance of Getting it Right the First Time

TransUnion Healthcare
Blog Post02/01/2019
Introduction to Medicare Bad Debt — Medicare Advantage

In recent years, Medicare Administrative Contractors (MACs) have become more restrictive regarding cost report reopenings. This poses a major challenge for many hospitals which have adopted reopenings as a standard operating procedure to correct cost report submissions from prior years.

Why MACs are cracking down on reopenings

In the past, hospitals were allowed to request a reopening anytime they needed — as long as they complied with relevant CMS regulations. This resulted in a substantially heavy administrative workload on MACs.

Many MACs have since adopted stricter criteria for allowing cost report reopenings. This puts added pressure on hospitals to ensure they submit accurate and complete initial filings.

Errors can arise in multiple places in the cost report preparation process

Given the volume of coding and paperwork related to Medicare and Medicaid claims — as much as hospitals try to — it’s difficult to submit initial cost reports with 100% accuracy.

Historically, the dependence on manual data entry has been a source of errors. And while the digitization of medical records and hospital revenue cycle processes has helped reduce clerical mistakes, the massive increase in complexity driven by the change from ICD-9 to ICD-10 and the need to integrate data from multiple systems and sources remains an issue.

You can reduce the adverse impact on your hospital’s revenue by:

  1. Focusing on data governance and integrity across the entire organization to receive optimal reimbursement. Common pitfalls happen when data capture and reporting is incomplete, inaccurate, or simply not done in a timely manner. Given tight deadlines, it can also be a challenge to navigate all the disparate data sources in and outside of the hospital, and correlate the relevant data points.
  2. Investing in technology and built out processes to aggregate necessary data for preparing cost reports. Reimbursement teams also need to work with stakeholders in other departments throughout the hospital to ensure everyone understands the impact of their activities on total reimbursement.

Learn how TransUnion Healthcare solutions can help improve the quality of cost reports to ensure maximum reimbursement.

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