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Payment Integrity

Identify Medicare underpayments and streamline reimbursement processes to maximize earned revenue

Tackle complex Medicare reimbursement issues to ensure earned revenue gets paid

Government reimbursement is often met with complex rules and ever-changing regulations, making it difficult for hospitals to receive full payments. TransUnion Healthcare's Payment Integrity solutions focus on the payment areas where superior technology and deep domain experience can drive significant improvements in reimbursement — increasing efficiencies and bolstering your bottom line.

Transfer DRG

Identify Transfer DRG underpayments to recoup lost revenue. Incorrectly coded claims can result in lost Transfer DRG payments as high as $70k* per account. The process involved in recovering these underpayments — performing post-acute care transfer reviews, conducting internal audits and adjusting discharge disposition codes — is very manual and sensitive to Medicare regulation compliance.

Our Transfer DRG solution leverages advanced technology and the expertise of a seasoned Transfer DRG team to identify and recover Transfer DRG underpayments by:

  • Reviewing hospital and Medicare data sources
  • Identifying where qualifying post-acute care was not provided
  • Validating with Medicare and the post-acute care provider that care was not delivered
  • Correcting and appealing claims with Medicare

The solution offers flexible delivery options, including a fully-outsourced consulting service or a SaaS solution for the hospital to perform its own analysis. Transfer DRG review is also available on Medicare Advantage beneficiaries.

LEARN MORE ABOUT OUR TRANSFER DRG SOLUTION >

* Based on historical client results

Shadow Billing

Identify and properly shadow bill Medicare Advantage (MA) claims to maximize reimbursements. Shadow billing is a significant issue for teaching hospitals, and when not done correctly it affects the ability to collect the Indirect Medical Education (IME) component of payment, as well as the ability to reconcile and maximize Graduate Medical Education (GME) reimbursement.

Our Shadow Billing solution expedites the claim-review process and helps hospitals maximize their IME/GME reimbursement by:

  • Identifying all MA patients not properly identified at registration
  • Connecting to the Medicare Common Working File (CWF) across all Medicare regions and suffixes to identify members
  • Verifying that a shadow bill claim was billed and finalized through the Medicare Direct Data Entry (DDE) system
  • Reviewing claims to ensure accuracy

The solution is available as a fully-outsourced consulting service or as a SaaS solution.

Testimonial

"Over a 9-month period reviewed, TransUnion Healthcare found roughly 450 additional Part C claims which will add more than $100,000 to our hospital. They were able to use their automation to get this turned around in three weeks. I would definitely recommend working with TransUnion Healthcare."

— DIRECTOR OF REIMBURSEMENT, MIDWESTERN HOSPITAL

Accredations

STINGRAY's Transfer DRG

STINGRAY's Shadow Billing

1HFMA staff and volunteers determined that this product met specific criteria developed under the HFMA Peer Review process. HFMA does not endorse or guaranty the use of these products.

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