Maximize Your Ability to Identify Medicare Advantage Shadow Billing Opportunities

Most Medicare Advantage claims require the submission of a “shadow bill” to Medicare in order for the hospital to receive its Indirect Medical Education (IME) and Graduate Medical Education (GME) reimbursement. Over the years, many providers have developed a reliable process to ensure that Medicare Advantage shadow bills are submitted properly.

In some situations, Medicare Advantage patients may not be correctly identified at the time of registration. Only after a denial is received is the Medicare Advantage eligibility determined. In these cases, the normal shadow billing process may not occur when the claim is rebilled, and the hospital will miss the IME and GME reimbursement to which it is entitled.

BESLER’s BVerified^SM – IME web-based solution quickly identifies Medicare Advantage shadow billing opportunities.

After a discharge file is uploaded to the system, BVerified^SM – IME quickly reconciles Medicare Advantage discharges eligible for shadow billing and provides the beneficiary eligibility and claim information needed for rebilling. The complicated and tedious task of identifying these opportunities in the Medicare Common Working File is completely automated. Management reports track the identified claims and confirm that timely rebilling has taken place.

This unique, cost-effective and easy to use tool provides hospitals with the control they need to manage their billing in-house, facilitate process improvement and to accelerate the cash flow related to shadow bills.