Transfer DRG underpayment recovery is not necessarily a solved problem for most hospitals.
BESLER has conducted “second sweep” Transfer DRG reviews for many years. During a “second sweep”, we review the processes of internal hospital Transfer DRG underpayment recovery efforts and those of other vendors. The timing, the amount of automation applied and the scope of the primary review may all create opportunities to identify additional revenue.
On average, BESLER identifies 30% in additional Transfer DRG underpayments. That’s something we’ve experienced and verified over and over. But, we still come across those who think that amount of recovery is not feasible.
The reality is that who does the review matters. Technology, clinical knowledge, relationships with MACs and a deep understanding of the Transfer Rule all come into play when it comes to recovering underpayments. Not all reviewers are created equal.
Below are just two examples of situations where BESLER was able to recover significant revenue both after hospital internal reviews and after other vendors. The need for and benefits of reviewing Transfer DRG cases for underpayments are clear. The potential for revenue recovery is so great that it should be considered a best practice to regularly review the performance of any internal or vendor process in place.
Transfer DRG underpayment recovery after another vendor
A health system in Florida was working with a vendor to recover underpayments for claims impacted by the Medicare Post-Acute Transfer Rule.
- The system wanted assurance that all underpayments were identified and engaged BESLER Consulting to conduct a second sweep review.
- A three-year retrospective review was conducted by BESLER Consulting and $800k in additional revenue was identified and recovered over and above the primary review.
- BESLER worked collaboratively with the Recovery Audit Contractor, First Coast, and fine-tuned a process to ensure the hospital received the proper reimbursement. BESLER conducted all steps required to collect this additional revenue.
- Overall BESLER recovered 33% in underpayments over and above the primary review.
Transfer DRG underpayment recovery after an internal process
A health system in the Midwest had initially used a vendor to recover underpayments for claims impacted by the Transfer Rule, then transitioned the recovery efforts in-house. The health system wanted to validate their internal process and engaged BESLER to conduct a second sweep Transfer DRG underpayment review.
- A four year retrospective review of claims from their 5+ hospitals yielded an additional $7 million in revenue.
- The system was able to utilize the review findings to improve its internal processes and results.
Read our special report to explore additional benefits of secondary Transfer DRG underpayment reviews.