IME and Transfer DRG Software Solutions

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 BVerified suite of Sanctions Screening, IME and Transfer DRG Software – putting the power of our expertise in your hands!

BVerified – Transfer DRG Software

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.

BVerified – 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.

BVerified– IME

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.

BVerified – 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. BVerified-IME finds these billing exceptions automatically.