Teaching hospitals receive a payment from Medicare for Indirect Medical Education (IME) and Graduate Medical Education (GME) expenses. This payment helps to defray the added costs of maintaining teaching programs. For traditional Medicare patients, the IME payment is automatically paid by Medicare when a claim is processed.
For most Medicare Advantage claims, however, a separate request to Medicare must be made to receive the IME payment. Hospitals make this IME payment request by submitting a “shadow bill.” GME payments are determined at cost report settlement, and are impacted by the number of Medicare Advantage days reported.
Over the years, many providers have developed a reliable process to ensure that Medicare Advantage shadow bills are submitted properly. In some situations, however, 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 not receive the added IME and GME reimbursement to which it is entitled.
BESLER’s IME Revenue Recovery service quickly identifies Medicare Advantage shadow billing opportunities. We efficiently reconcile Medicare Advantage discharges eligible for shadow billing and provide the beneficiary eligibility and claim information necessary for rebilling.
The complicated and tedious task of identifying these opportunities in the Medicare eligibility and billing systems is handled by our proprietary technology. We identify shadow bills that were not submitted, whether or not the hospital originally identified a patient as Medicare Advantage.
Detailed management reports track the identified claims and confirm that timely rebilling has occurred.
BESLER also offers the BVerified suite of web-based solutions, which allows providers to bring the work of identifying, prioritizing and recovering Medicare Advantage shadow bill underpayments in-house.