Article | Medicare Compliance RAC OIG

BESLER: Full-service Transfer DRG revenue recovery

Sponsored by BESLER
Article | Medicare Compliance RAC OIG

BESLER: Full-service Transfer DRG revenue recovery

How do you help healthcare organizations navigate the biggest challenges in healthcare?

Changing regulations often cause unintended challenges for the healthcare industry. Besler creates clear and simple paths through these challenges, so that hospitals have more time and dollars to focus on enhancing patient care.

Taken together, Medicare and Medicaid represent the largest sources of healthcare spending and are major revenue drivers for most hospitals. Over the last thirty years, Besler has developed deep expertise around these federal programs, allowing us to offer a range of payment and revenue recovery solutions that help our customers recover revenue they have rightfully earned while maintaining compliance.

The proof is in the $4 billion of additional revenue we’ve delivered to hundreds of hospitals across the United States. To us, this is more than money. It means greater resources for our clients to hire key staff, add life-saving equipment and services and better serve their communities.

What advice would you offer to healthcare leaders when choosing among vendors?

It may sound cliché to say that not all vendors or services are alike, but it’s true. Take Transfer DRG revenue recovery. This type of service has been available for many years and continues to be offered by several vendors. When services reach that level of maturity, it may seem attractive to select the one that comes at the least expensive price.

However, there is more to the story.

For instance, a provider could ask a vendor if it reviews 100% of accounts impacted by the Transfer Rule. Some vendors only focus their efforts on a selection of claims that are essentially low-hanging fruit, without doing a thorough review across all impacted claims.

Compliance must be at the forefront of the review process. Multiple validation steps are important to minimize the risk of overpaid claims. Reliance solely on CMS’s Common Working File to determine if Transfer DRG claims have a recovery opportunity can lead to issues. A compliant validation process includes direct contact with post-acute providers and clinical staff reviews to ensure clinical compliance before an underpayment determination is made.

Ask vendors probing questions to determine their ability to deliver optimal results, which will keep your hospital compliant with Medicare regulations.

What is some advice you can give providers for a successful implementation of a new product or service?

Your vendor partner should be able to communicate what is needed to successfully fulfill an engagement. Familiarize yourself with their requirements and place the appropriate staff members in positions to facilitate the work. Lack of communication or inability by the provider to deliver necessary information or decisions can hamper implementation. Be open with your vendors about your capabilities, timelines and resources so they can work with you to overcome potential roadblocks.

Quick Facts

Number of years on the Short List: Six

100% of respondents agree or strongly agree that they would recommend Besler’s Transfer DRG revenue recovery service to a colleague.

About BESSLER

BESLER combines best-in-class healthcare finance expertise with proprietary technology to help hospitals recover more revenue. Our reimbursement and revenue recovery solutions have delivered more than $4 billion of additional revenue to hundreds of hospitals across the United States. We serve as advocates for hospitals, so that they, in turn, can better advance the health and well-being of their patients.

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