Maximize Your Ability to Identify, Prioritize and Recover Transfer DRG Underpayments

Under the Medicare Post Acute Transfer rule, acute care providers are paid less than the full DRG payment for many claims when the patient is transferred to another facility or home health upon discharge. In some cases, the care plan is not followed as expected and the transferring hospital may be entitled to the full DRG payment. While CMS instructs Medicare contractors to edit transfer claims for potential overpayments, edits for underpayments do not exist.

Without significant manual effort and examination of the Medicare Common Working File, acute care providers have no way to identify those transfer claims for which they have been underpaid.

BESLER’s BVerified^SM – Transfer DRG web-based solution automates this process to quickly identify, prioritize and recover Transfer DRG underpayments.

After a discharge file is uploaded to the system, BVerified^SM – Transfer DRG quickly identifies all claims which have potentially been underpaid. The complicated and tedious task of identifying these opportunities in the Medicare Common Working File is completely automated.

Once potential claims have been identified, the compliance-focused workflow tools walk the user through the process of contacting the appropriate post acute care providers and fiscal intermediary to definitively determine the underpayment status. Extensive auditing and reporting features track the identified claims and confirm that timely rebilling has taken place.

This unique, cost-effective and easy to use tool provides hospitals with the control they need to manage their billing in-house and ensure their workflow is fully compliant with Medicare billing policies.

To see the BVerified^SM – Transfer DRG tool for yourself, please contact Jeffrey A. Lampman at 609.514.1400 or jlampman@besler.com.