Medicare underpayments can occur when a patient is discharged as a “transfer,” but there is no post acute-care billing. This often happens when a patient decides to forego the recommended post-acute discharge. When a patient decides not to transfer to a post-acute facility in accordance with CMS rules, the discharging hospital is entitled to the full DRG payment but only receives partial payment. When this happens, it’s up to your hospital to recuperate the full payment it’s due.
Transfer DRG allows us to conduct underpayment audits for your organization to ensure you are reimbursed for those claims. Our automated processes require only a minimal data set to identify eligible claims, resulting in a fast turnaround.
Every Claim Examined
Automated search of 100% of variances with minimal data set (15 fields)
Audit and correction of discharge status codes for the previous four years
Direct contact with FI/MAC, SNF, HHA to validate accuracy of corrections
What makes eSolutions’ Transfer DRG different?
- Unique relationships with MACs
- Intelligence built into our solution
- Actual recovery in as little as 14 days
- Verifiably non-disruptive
- Medicare Advantage also reviewed
- Comprehensive condition code review
|Transfer DRG||With eSolutions' Medicare Enterprise||Standalone|
|Compliant with HIPAA|
|Compliant with PACT rules|
|Claim correction included|
|No medical record pulls|
|No additional Medicare enrollments|
|No data extracts required|
|Time to reimbursement||2 weeks||4-6 weeks|
$100+ MILLION recovered for healthcare providers
average recovery per underpaid claim