Medicare Transfer DRG Revenue Recovery


Background

CMS believed that hospital providers were rushing patients out of the hospital and into post acute care settings in order to maximize their profits. The OIG issued a report in 2001 stating, “Our report indicated the CMS has no controls or edits in place in the common working file (CWF) to prevent excessive payment”. The report indicated that of the claims reviewed by the OIG resulted in 99% error rate resulting in $52 million in improper payments. The OIG issued a second report in 2003 indicating a 95% error rate or $61 million in improper payments.

CMS’s response was to implement an edit to identify those patients improperly coded as discharged to home who in actuality were getting post acute care services. This is a one‐way edit and only looks for instances where the provider was overpaid.

Our Solution

RSG Inc. has partnered with IMA Consulting to provide Transfer DRG Services to our clients.  IMA’s professional staff has over 24 years experience in healthcare with backgrounds in revenue recovery, reimbursement, litigation support, compliance and finance.

Utilizing these various backgrounds, we developed a methodology that is efficient, compliant with government regulations and client friendly, requiring little investment of your resources. IMA Consulting utilizes a team of Nurse Coders to assist in the Medical Record review to ensure the highest quality and most accurate results.

Transfer of Knowledge

One of IMA Consulting’s core beliefs is your staff should be in charge of the process whenever possible. Another one of our core beliefs is that we should transfer our knowledge, skills, and methodology to your staff. Accordingly, the IMA Consulting’s solution does not end with a written report. We place high value on the education of our client’s staff during our delivery meetings. This transfer of knowledge distinguishes IMA from others providing this service.

Results

We have performed Transfer DRG reviews over 2,700 times and are the leaders in the industry with regard to expertise and methodology.  The results we produce for our clients are consistently in line with our original estimates. And, our recoveries are typically 15% higher than industry averages and 40% more than providers who completed similar reviews internally.