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Medicare Cost Reporting

Increase Medicare reimbursements, automate complex processes and recover more revenue

Medicare Bad Debt

Maximize reimbursement for unpaid Medicare coinsurance and deductibles. Medicare Bad Debt (MBD) represents a significant revenue source for hospitals — 65% of the eligible amount of MBD they incur. However, complex rules regulating Medicare bad debt processes and reporting make it hard to recover these payments.

TransUnion Healthcare’s Medicare Bad Debt solution addresses these challenges by automating the MBD review process. By leveraging the unique processing and data integration capabilities of our STINGRAY™ platform — the industry’s only Software-as-a-Service (SaaS) solution for MBD — hospitals can accurately and efficiently identify reimbursable bad debts by:

  • Ensuring all categories of MBD are studied, including crossovers, traditional self-pay, and indigent/charity care
  • Identifying coinsurance and deductible amounts from Medicare claims
  • Cross-referencing against state Medicaid paid-claims information
  • Eliminating non-allowable deductible and coinsurance amounts
  • Reconciling remaining amounts against the hospital’s encounter and transaction data
  • Reconciling against previous submissions to accurately report recoveries in current periods
  • Delivering accurate findings in a format that’s easy to submit to CMS

 

This solution can be delivered as a fully-outsourced consulting service or as a SaaS solution.


Learn more about our Medicare Bad Debt solution >

Medicare Bad Debt – Medicare Advantage

Maximize reimbursements for unpaid Medicare coinsurance and deductibles incurred by Medicare Advantage (MA) members. With more than 30% of all Medicare beneficiaries enrolled in a MA plan, Medicare Bad Debt – Medicare Advantage (MBD-MA) represents a significant revenue opportunity. MBD-MA is complex as it deals with multiple plans that don’t administer it consistently. This makes it even harder to obtain reimbursements without a robust, automated system in place.

Our automated MBD-MA solution utilizes the STINGRAY™ platform to identify reimbursable bad debts by:

  • Capturing all eligible Medicare Advantage bad debts
  • Automating the data aggregation, integration and analysis required for Medicare Advantage Bad Debt
  • Unlocking the full reimbursement potential of your Medicare Advantage contracts
  • Ensuring listings are filed in a timely manner and to the appropriate commercial Medicare Advantage plan


Learn more about our Medicare Bad Debt – Medicare Advantage solution >

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Medicare Disproportionate Share (DSH)

Identify all patient days eligible for DSH reimbursement to increase payments. Medicare DSH payments are a vital funding source for hospitals that serve low-income populations, but aggregating and integrating the patient data needed to qualify for these payments is challenging.

Our Medicare DSH solution — backed by the unique SaaS platform STINGRAY™ — helps identify DSH eligible patients and patient days by:

  • Scrubbing patient encounter data to improve match results with Medicaid eligibility data
  • Identifying all mom/baby matches
  • Removing any paid Medicare claims by matching the Medicare Provider Statistical and Reimbursement (PR&R) report to the final Medicaid log
  • Leveraging proprietary processes to ensure all appropriate Medicare records are removed from the Medicaid fraction, even those that are eligible but not paid
  • Delivering results with full documentation required for Medicare submission

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

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Uncompensated Care Analytics

Ensure Worksheet S-10s are complete and accurate to streamline uncompensated care payments.

TransUnion Healthcare’s Uncompensated Care Analytics solution was one of the first products offered in the industry to help hospitals complete Worksheet S-10. The solution provides:

  • Core data points needed to complete Worksheet S-10
  • Detailed documentation to facilitate the audit process
  • Analysis of the impact your results will have on your uncompensated care payments
  • Benchmarking against peer hospitals


Contact us to learn more about uncompensated care analytics >

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Volume Decrease Adjustment (VDA)

Determine eligibility to qualify for VDA reimbursements. This Medicare payment adjustment — for Sole Community Hospitals or Medicare-dependent hospitals that experience an annual decline in discharges greater than 5% due to external factors — can impact overall yield.

We offer the experience and analytics required to help hospitals become qualified for VDA by:

  • Reviewing legal and regulatory requirements to determine VDA qualifications
  • Identifying drivers behind decreased discharges to determine VDA eligibility
  • Determining eligible adjustment amounts based on VDA regulations
  • Preparing all necessary documentation for submitting the VDA request to Medicare


Learn more about our VDA solution >

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Testimonial

“We are a 21-bed hospital and every dollar of reimbursement is important to help us deliver excellent patient care. TransUnion Healthcare’s work recovered over $300,000 for us, exceeding our expectations. We couldn’t be more thrilled with the results.”

— Controller, Southern hospital

Accreditations

STINGRAYTM
•Medicare Bad Debt
•Medicare Disproportionate Share

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.

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