BESLER Consulting is committed to advising you of timely and pertinent healthcare news through our blog, presentations, industry articles, special reports, white papers and more. As the Medicare regulations are updated and developments arise, we will provide relevant content to assist you in navigating the changes, calling your attention to key areas of focus. Whether it is financial or clinically related, BESLER is ready to decipher these complex areas and assist in analysis, planning and implementation.
Transfer DRGs: Approaches to Revenue Recovery
Under Medicare reimbursement regulations, when certain patients are discharged to post acute care, the discharging hospital is paid at a reduced rate. In some cases, this reduced payment is not justified by the actual post-discharge care. These underpayments are not reflective of coding or billing errors on the part of the provider, but more commonly result from a change in the planned course of treatment subsequent to discharge.
This white paper discusses solutions that allow hospitals to recover the revenue they’ve properly earned when they’ve been underpaid due to the Transfer Rule. Many of the issues and solutions discussed in this white paper also apply to Medicare Advantage transfer claims.
Hospital Observation Services
Hospitals are facing several worrisome industry trends such as decreasing inpatient admissions, increasing “observation admissions” and more medical necessity denials resulting in financial challenges. Many are under pressure to balance inpatient admissions with observation services. A properly deployed observation service has the potential to achieve cost savings for the hospital and improve patient care and satisfaction.
This white paper discusses several approaches to the implementation of observation services and provides best practice advice on optimal approaches for structuring observation services.
CMS Sanctions Screening Best Practices
Healthcare providers are prohibited from employing or contracting with excluded persons. Individuals and organizations are excluded from the Medicare and Medicaid programs for various reasons, including fraudulent billing, abuse of patients, controlled substance convictions and other prohibited activities.
Those that do are subject to significant fines, and will be not be paid by federal government healthcare programs for any services provided directly or indirectly by excluded individuals or organizations.
To ensure that they do not employ or contract with excluded persons and companies, providers must check various federal and state exclusion lists, such as the OIG’s List of Excluded Individuals (“LEIE”). This white paper discusses best practices for screening employees and other individuals and companies against these lists.