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Who took my money?

August 2010

By: Robin Bradbury, Lead Revenue Cycle Advisor

On June 25, 2010, President Obama signed into law the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (HR 3962). This law effectively removed a valid opportunity to retroactively and prospectively unbundle Medicare inpatient claims that had outpatient charges "bundled" when the charges were non-diagnostic in nature, did not "relate" to the inpatient diagnosis and were within the three day window prior to the inpatient admission.

Make no mistake about the reason for this portion of the legislation. CMS estimated that $5 Billion over the next ten years would have been paid to hospitals as a result of projects being pursued by healthcare providers. This effectively takes $500 Million per year away from hospital Medicare reimbursement.

In an era of RAC audits, revocation of unbundling opportunities and further reductions in Medicare reimbursement coming, how do hospitals keep their head above water?

The answer lies in receiving full reimbursement for all the services hospitals provide. In the outpatient arena, hospitals are leaving money on the table because they fail to confirm that all charges are captured. Looking at every claim is impractical, but using software that does this for you is easy if you have the right tool.

We can help. Call us to discuss our re|charge "code pairing" opportunity. Clients pay nominal up-front fees and they only pay if additional reimbursement is received. Help hospital organizations fight back and keep what is rightfully theirs.

If you have any questions and would like to learn more about this opportunity, please feel free to contact us directly, 559-447-4488.