Medicare Cost Reporting

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

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.

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

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