Transfer DRG Revenue Recovery


The Centers for Medicare and Medicaid Services (CMS) pays for Medicare inpatient hospital care on the basis of Diagnosis Related Groups (DRGs). Certain DRGs (known as Transfer DRGs) are paid under the Medicare Post Acute Transfer rules, which reduce payments for hospitals that transfer patients to other providers to continue treatment.

Beyond the transferring hospital’s control, a significant number of patients are not treated as planned after being transferred. This results in an unwarranted reduction in the transferring hospital’s Medicare reimbursement. The impact to US hospitals is in the hundreds of millions of dollars per year.

Properly reviewing the post-transfer care that patients receive and identifying underpayment situations can provide hospitals with a significant revenue boost.

BESLER’s Transfer DRG Revenue Recovery Service identifies patients transferred to post-acute care for which Medicare’s payment, upon retrospective review, was less than the transferring hospital was entitled to receive.

The retrospective review and recovery process is complex and tedious. Hospitals don’t usually have the level of resources required to validate that post-acute care was in fact provided to the patient. BESLER’s reimbursement and revenue cycle expertise, combined with our proprietary technology, provides hospitals with the comfort that the recovery effort is appropriate, compliant and effective.

Even after another vendor has reviewed a hospital’s Transfer DRG cases, BESLER’s second sweep of the same claims often identifies 30% or more additional revenue.

BESLER’s Transfer DRG Revenue Recovery Service fees are fully contingent and are billed only after the client receives additional payment. BESLER also offers the BVerified – Transfer DRG solution, which allows providers to bring the work of identifying, prioritizing and recovering Medicare Transfer DRG underpayments in-house.