Article | Medicare Payment and Reimbursement

TransUnion’s Transfer DRG solution simplifies the underpayment process

Sponsored by TransUnion Healthcare
Article | Medicare Payment and Reimbursement

TransUnion’s Transfer DRG solution simplifies the underpayment process

How do you help healthcare organizations navigate the Transfer DRG recovery process?

Identifying Transfer DRG underpayments can be a challenging, tedious process. Hospitals must validate post-acute care activity, adjust discharge disposition codes and track rebill payment status, all while maintaining compliance with Medicare regulations. These challenges are tough to overcome without a dedicated solution or partner. 

TransUnion’s Transfer DRG solution simplifies this process by leveraging its STINGRAY™ platform, a unique Software as-a-Service (SaaS) solution for managing the Transfer DRG process. STINGRAY’s superior processing and data integration capabilities help hospitals identify and recover more Transfer DRG underpayments, even when coming in behind other vendors. We have a 99% success rate in getting Transfer DRG claims paid.

In our experience conducting hundreds of post-acute care reviews, we have historically seen 2% of Medicare discharges eligible to be rebilled for full DRG payments under Medicare’s transfer DRG rules. At an average incremental recovery amount of approximately $2,800 per claim, this is a reimbursement opportunity too big to ignore.a

What advice would you offer to healthcare leaders when choosing among vendors for a Transfer DRG solution?

Maximizing reimbursement for complex Medicare payment issues requires leading-edge technology that can gather, validate and integrate disparate data sets from multiple sources. STINGRAY’s seamless integration and analysis of these data sets, plus superior algorithms that maximize Medicare Beneficiary Identifier lookup and claims scraping, allows TransUnion Healthcare to identify Transfer DRG reimbursement opportunities missed by other vendors.

Many hospitals use multiple vendors for Transfer DRG, running in first, second and third place. If your current vendor isn’t converting approximately 2% of Medicare claims, there is likely revenue left on the table.

Consider how the vendor validates post-acute care activity, as this will affect their payment success rate. TransUnion Healthcare interfaces directly with Medicare to automatically identify important eligibility and claims data, then our Transfer DRG team verifies the patient “level of care” directly with post-acute care providers.

Partners should also provide flexible delivery options. We offer fully outsourced consulting or Software-as-a-Service for Transfer DRG, with the option to outsource the billing and/or billing follow-up to our team.

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

A Transfer DRG partner should communicate up front what data they need to complete your project, be available and responsive when you have questions and be proactive in resolving any issues that may arise. Our seasoned Transfer DRG team provides consultative, high-touch client support and leverages long-standing relationships with MACs to expedite the recovery process.

For our outsourcing clients, we average two weeks to extract patient data by using pre-built scripts for most Patient Accounting Systems. Our hands-on data extraction team works with each client to configure automated, recurring data feeds — eliminating the need to engage scarce IT resources year after year. 

Quick Facts

  • 11 years on the Short List 
  • 100% of peer reviewers would recommend TransUnion Healthcare’s Transfer DRG service to a colleague

About TransUnion Healthcare

TransUnion Healthcare, a wholly owned subsidiary of TransUnion, makes mutual trust possible between patients, providers and payers by helping them navigate payment complexities. Our Revenue Protection® solutions leverage comprehensive data, accurate insights and industry expertise to engage patients early, ensure earned revenue gets paid and optimize payment strategies. TransUnion Healthcare helps over 1,850 hospitals and 570,000 physicians collectively recover more than $1.2 billion annually in revenue.

To learn more about HFMA’s Peer Review program, visit hfma.org/peerreview

Footnotes

a. Based on historical client results.

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