Hospitals can recover all eligible Medicare bad debts by automating the Medicare bad debt review process

How do you help healthcare organizations navigate the biggest challenges in healthcare?

Complex rules regulating Medicare bad debt processes and reporting make it hard for hospitals to recover these payments. TransUnion Healthcare’s Medicare Bad Debt solution addresses these challenges by automating the Medicare bad debt review process. By leveraging the unique processing and data integration capabilities of our STINGRAY™ platform, hospitals can accurately recover all eligible Medicare bad debts, including crossovers, traditional self-pay and indigent or charity care.

Historically, our proprietary process has increased Medicare bad debt reimbursements by up to 25% over internal efforts while maintaining a 95% audit success rate. With our automated process, clients have found more than $136K in additional Medicare bad debt reimbursements per fiscal year, on average.

In addition, the root cause analytics and account-level detail provided by STINGRAY help reimbursement and revenue cycle teams perform a “mid-year review” to proactively identify and correct problem bad debt accounts before they go to an untimely status.

What advice would you offer to healthcare leaders when choosing among vendors?

Maximizing reimbursement for complex Medicare payment issues requires technology that can gather, validate and integrate large and disparate data sets from multiple sources. STINGRAY’s seamless integration and analysis of these data sets allows identification of reimbursement opportunities missed by other vendors.

To maximize their Medicare bad debt reimbursement, hospitals should choose a partner with a deep understanding of hospital information systems and business processes, as well as expert knowledge of complex CMS regulations and the often-inconsistent way in which MACs administer these regulations.

Partners should also be able to provide flexible delivery options. Our clients can choose to outsource their Medicare bad debt review to us, with TransUnion Healthcare using STINGRAY to run all projects, or they can choose STINGRAY SaaS (software-as-a-service) to implement the platform in-house for their teams to access in-depth analysis and prepare final reports/logs. We also offer a hybrid outsource/SaaS option, giving our clients even more control over their Medicare bad debt review and recovery process.

What is some advice you can give providers for a successful implementation of a new product or service?

A Medicare bad debt partner should communicate up-front what data is needed to complete the project, be available and responsive when the client has questions and be proactive in resolving any issues that may arise.

For our outsourcing clients, we average two weeks to extract patient data by using pre-built scripts for most Patient Accounting Systems. Our hands-on data extraction team works with each client to configure automated, recurring data feeds — eliminating the need to engage scarce IT resources year after year.

We provide full-level support to our STINGRAY SaaS clients throughout the implementation process. Our team of experts provides in-depth client training during the key aspects of system setup and data loading. Once STINGRAY SaaS is operational, we provide the training needed to use the system and a full team of client service, project management, operations and technical staff to ensure success. 

Quick Facts

• Time on the Short List: 11 years
• 100% of peer reviewers would recommend TransUnion Healthcare’s Medicare Bad Debt service to a colleague.

About TransUnion Healthcare

TransUnion Healthcare, a wholly owned subsidiary of TransUnion, makes mutual trust possible between patients, providers and payers by helping them navigate payment complexities. Our Revenue Protection^® solutions leverage comprehensive data, accurate insights and industry expertise to engage patients early, ensure earned revenue gets paid and optimize payment strategies. TransUnion Healthcare helps over 1,850 hospitals and 570,000 physicians collectively recover more than $1.2 billion annually in revenue.

To learn more about HFMA’s Peer Review program, visit hfma.org/peerreview