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.
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:
The solution offers flexible delivery options, including a fully-outsourced consulting service or a SaaS solution for the hospital to perform its own analysis.
* Based on historical client results
Detect highly likely Medicare underpayments for previously submitted inpatient claims. With the shift to ICD-10 and other internal constraints, it's challenging for hospitals to properly code and assign the DRGs that will provide their entitled reimbursements, especially in highly complex cases.
Our Complex DRG solution helps hospitals identify and re-file Medicare inpatient claims where the medical record supports the assignment of a higher DRG payment, and also:
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:
The solution is available as a fully-outsourced consulting service or as a SaaS solution.
"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
1 HFMA staff and volunteers determined that these products met specific criteria developed under the HFMA Peer Review process. HFMA does not endorse or guaranty the use of these products.
A Better Patient Experience Benefits Everyone
Uncompensated Care Reimbursements: Navigating the Uncertainties of Worksheet S-10
How Utilizing SDOH Data Can Make a Big Difference in Predicting Risk and Managing Care
FY 2020 Hospital Inpatient PPS Final Rule Update: Worksheet S-10 and Uncompensated Care