Are you validating the results of your in-house auditing staff or third-party vendor for your Medicare Transfer DRGs?

If not, call us. We provide a validation of the work completed by in-house auditing teams and outside contractors. We offer this service free of charge — all we ask is that we re-bill any findings on your behalf and invoice you for our contingency fee. If we find nothing, then your work is validated, and you pay nothing. If we do uncover revenue, we’d like you to consider working with us when your current vendor contract expires.

With our 3D Audit, we have the ability to review records up to the previous four years, retrospectively.

All we need to get started is an extract file from your patient accounting systems and access to medical records.

Benefits of the Retrospective Approach

 

Hospitals often believe they are getting all of the recovery from Transfer DRGS by using a concurrent process.  Although a determination for a Transfer immediately following a hospital stay can be made, there are several issues that will arise that may make that determination less than accurate.

 

 

Example:  A patient is discharged to home health care for oxygen treatments based on the physician orders. The discharge disposition code 06 – Patient discharged home with home health services – is applied.  Once the patient gets home he may or may not contact the home health provider to arrange for the oxygen treatments, or he may wait more than three days to make those arrangements.  In either of these situations, the discharge disposition code of 06 would not be appropriate.

 

 

Even in cases where a hospital might contact the home health provider or review the common working file (CWF), accurate information from the post acute provider still may not be received. Since providers often accumulate billing and only submit charges to CMS bi-monthly or monthly, checking the CWF will be delayed by a few weeks or even months.

 

 

The same holds true for a discharge to a skilled nursing facility (SNF). Coding a 03 – Patient discharged/transferred to a licensed skilled nursing facility – may seem logical if the physician orders indicate that the patient should be discharged to a skilled bed. In fact, the patient will be evaluated at the SNF to verify eligibility for a skilled bed. We also find that sometimes a skilled bed is not available at the facility.  Follow-up calls to the SNF may or may not uncover whether skilled services were provided.  Again, simply reviewing the CWF may not readily indicate that eligible services were charged.

With one of the most exhaustive processes in the industry, we guarantee to collect underpayments for you.

We will:

• Data mine to extract all potential underpayments utilizing our proprietary software.
• Review In-Episodes which hospitals typically miss due to the discharge disposition being changed by CMS after the billing has been submitted.
• Call the post-discharge facility and verify the level of care.
• Provide detailed documentation including written treatment and billing verification for the patient’s permanent record.
• Validate all findings through the CWF, the post-acute care facility, and again with the FI or MAC to ensure accuracy and compliance.
• Review of discharge disposition codes for anomalies and trends that could present compliance issues.
• Segregate non-Medicare post-acute care facilities for discretionary re-billing by the client.

We recently worked with a health system in California that engaged a third-party vendor for their Medicare Transfer DRGs. Working behind this vendor – record for record – we found an additional $500,000 in revenue that they had missed.

With no out of pocket costs, we will perform an analysis of your Transfer DRG Recovery effort and validate the work of your in-house auditors and 3rd Party Vendors