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Top Four Mistakes Hospitals Make When Capturing Data for Medicare Reimbursement

Capturing data properly can be the difference between obtaining all the Medicare reimbursements your hospital is entitled to and suffering compliance errors or negative audit adjustments. Correctly archiving relevant datasets can be equally important when it comes to maximizing your Medicare reimbursements, especially during an audit.

Since 2015, Medicare has taken back over $500 million in once-reportable Medicare bad debt. This staggering — and growing — number indicates one of two things for those hospitals that lost this reimbursement:

  1. They were out of compliance with the Medicare bad debt regulations at the time their cost report was filed
  2. They couldn’t provide enough data to support the listings on their initial cost reports upon audit

Learn how to maximize your Medicare reimbursements by avoiding these four common mistakes:

Mistake #1 – Not planning ahead for audits

Patient and treatment data must often be retrieved multiple years after an initial filing. In fact, it’s not uncommon for hospitals to be required to dig up information over a decade old. As it relates to audits by a Medicare Administrative Contractor, in order to support reimbursement under review, you’ll need to supply past remittance advices and charity applications, as well as other data.

The key to success is putting in the effort required to ensure your data is archived and warehoused in a way that it can be recovered easily in the future.

Mistake #2 – Failing to comply with regulations

When assembling its Medicare Bad Debt listings, a hospital must complete a number of required fields. If those fields aren’t aggregated accurately, you run the risk of an issue being identified during an audit.

For example, if you can’t capture the correct remittance dates, write off dates or dates to the patient, you’ll be at risk — leading to the exclusion of your entire bad debt listing.

Mistake #3 – Mismanaging personnel and data

Staff working Medicare reimbursement accounts need to understand the ins and outs of Medicare — and be able to work with large and disparate datasets, as well as various internal and external departments.

Even the most talented and organized team will have limited impact without high-quality, accurate data that has been captured and stored properly. If the dataset isn’t organized in a way that links relevant pieces of information together and communicates the data coherently, your reports will underachieve from a reimbursement perspective.

Mistake #4 – Using the wrong tool for the job

Using the wrong technology and tools to uncover reimbursements can make otherwise strong data ineffective.

Many hospitals use Excel spreadsheets for making sense of reimbursement data. Others use canned reports prepared by somebody on the IT team who might not fully understand how the data needs to be used — or the potential financial impact of errors.

You need a platform that’s not only up to date with Medicare regulations, but also current with your databases and requirements of third parties in your reimbursement ecosystem.

Learn how to maximize your reimbursements and minimize compliance errors with TransUnion Healthcare’s Medicare Cost Reporting solutions.


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