Medicare underpayments occur when a patient is discharged from your facility as a “transfer”, but there is no Post-Acute Care (PAC) billing. This often happens when the patient decides to forego Post-Acute Care treatment in accordance with CMS rules. This means your facility is entitled to the full DRG payment. Unless a specific underpayment audit is conducted periodically the revenue loss will persist and continue to grow. Our Medicare Underpayments Solution proprietary software reviews all 275+ Diagnostic-Related Groups subject to CMS Post-Acute transfer rules. Our platform reduces human error and conducts a full, comprehensive review of 100% of the claims much more quickly and accurately thus, speeding up the recovery of underpayments for you.
Working claims older than 365 days takes knowledge and experience to reopen these claims and make the necessary adjustment proving “good cause” is present. Our business relationship with CMS allows us to go back 48 months and gather the most accurate data provided to your Common Working file. Accordingly, we then make all of the necessary adjustments and transactions on your behalf. This also allows us to do 98% of the work and review 100% of your Medicare inpatient discharges; you only need to provide an initial data file and approve adjustments. You reap all the benefits from our ability to adapt in an environment that is constantly changing.