For over 25 years, BESLER Consulting has been assisting healthcare providers in an ever-changing healthcare environment. Our clients consistently report that revenues have been enhanced, operational efficiencies have been gained and compliance has been achieved as a result of partnering with us.
As the industry changes, we believe that our clients can and need to use their internal resources for many of the new regulatory compliance and reimbursement functions. That is why BESLER Consulting is developing the BVerifiedSM
suite of cloud-based solutions - putting the power of our expertise in your hands
BVerifiedSM – Transfer DRG | Pdf Download | Read More >>
Click here to see an overview of our BVerified SM -Transfer DRG Solution
Under the Medicare Post Acute Transfer rule, acute care providers are paid less than the full DRG payment for many claims when the patient is transferred to another facility or home health upon discharge. In some cases, the care plan is not followed as expected and the transferring hospital may be entitled to the full DRG payment. While CMS instructs Medicare contractors to edit transfer claims for potential overpayments, edits for underpayments do not exist. Without significant manual effort and examination of the Medicare Common Working File, acute care providers have no way to identify those transfer claims for which they have been underpaid.
BVerifiedSM - Transfer DRG automates the tedious identification and follow-up process required to validate the accuracy of post-acute transfers. The required review of the Medicare Common Working File is completely automated. A flexible workflow tool guides the user through the remaining follow-up tasks and ensures that final discharge status determinations are made in a compliant manner.
BVerifiedSM – IME | Pdf Download | Read More >>
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.
BVerifiedSM – IME automates the detection of additional Medicare Advantage Indirect Medical Education (IME) shadow bills. While many hospitals have an adequate shadow billing process in place for claims identified at registration as Medicare Advantage, at times, this process can break down and Medicare Advantage claims go unbilled. BVerifiedSM-IME finds these billing exceptions automatically.
BVerifiedSM – Screening and VerificationSM | Pdf Download | Read More >>
Under Federal regulations, CMS will not reimburse providers for services rendered by individuals and organizations that have been excluded from federal healthcare programs due to fraud and abuse convictions. When a provider discovers that one of its employees or vendors is found on the list of excluded parties, it is obligated to report this to CMS.
BVerifiedSM – Screening and VerificationSM is an easy to use, automated solution which allows unlimited screening of your employees, caregivers, contractors and vendors against Federal and State Databases. Additionally, the software can be used to verify your caregivers’ license information against state databases. The web based solution produces concise results and is backed by a company of compliance experts.