Transfer DRG Services
Identify and recover underpayments to improve cash flow
Several years ago, the Centers for Medicare and Medicaid Services (CMS) implemented protocols for identifying overpayments associated with patient transfers from acute care hospitals to post-acute care facilities (e.g., SNF, inpatient rehab facility, home care).
In many instances, overpayments resulted from reimbursing both the acute care facility and the post-acute care facility at the full DRG rate. As a result, CMS established "Transfer DRGs (TDRGs)" with corresponding edits, checks and balances incorporated into its payment systems. Essentially, upon receiving a claim from a post acute care provider, CMS checks for a corresponding inpatient acute care claim. If the acute care provider's claim indicated that the patient was discharged home and the provider received the full DRG rate, CMS would initiate a take-back of the original payment and issue a reduced payment.
At the same time, however, CMS takes the position that it is up to the provider to identify any underpayments, which requires additional work, re-billing and potential unrecovered cash for acute care providers.
Potential impact
The number of qualifying TDRGs grew from an initial 10 in 1999 to 273 in 2007. The result is an increase in the potential negative impact on a hospital's reimbursement. On average, 60 percent of Medicare inpatient discharges have a TDRG, and 1-3 percent of Medicare inpatient discharges are underpaid. At an average additional reimbursement per case of around $2,000, this translates into additional annual reimbursements of approximately $200,000 for a typical 250-bed hospital.
The Solution
To address this issue, CareMedic is offering its customers a TDRG reimbursement recovery service that identifies underpayments (as well as overpayments) on behalf of the healthcare provider. The results highlight the opportunity to re-bill Medicare for reimbursement of the underpayments.
For our MedicareRT customers, CareMedic can initiate TDRG reimbursement recovery service using claim data stored in your MedicareRT database. You can start using the service without any visible disruption in your workflow procedures or data. We can also work with non-MedicareRT customers to retrieve the needed data and initiate the services.
We offer this expert, comprehensive TDRG reimbursement recovery service at no risk to you. Our fee is based on contingency--you only pay a percentage of what is recovered. If you don't get paid, we don't get paid.
TDRG reimbursement recovery service:
- Addresses inpatient Medicare, Medicare managed care, and TriCare (CHAMPUS) discharges for potential recoveries for the previous 1-4 years
- Identifies discharge status errors
- Includes individual claim review
- Provides extensive reporting of both progress and results
- Employs a multi-level QA process, including contacts with the payer and/or the post acute care provider
- Includes re-billing the payer at no additional cost (if desired) and all follow-up to ensure resolution
- Uses off-site staff to minimize disruption and onsite office needs
- Accommodates large volume account reviews
Benefits
- Brings in previously undetected "lost" cash
- Eliminates risk with contingency-based fees
- Assists in preventing discharge variances where possible
- Includes review of both HHA and SNF claims, increasing potential recovery
- Requires no up-front costs or implementation fees
- Satisfies compliance requirements for Correct Claims Filings
- Saves staff time by providing personal phone follow-up with payers and providers
Find out how you can recover more cash for your organization with TDRG revenue reimbursement services today. For more information, contact us via the Web or call us at 1-800-508-8494.