TransUnion Medicare DSH solution helps hospitals identify reimbursement opportunities

How do you help healthcare organizations navigate the biggest challenges in healthcare?
Medicare Disproportionate Share hospital (DSH) payments are a vital source of funding for hospitals that serve low-income populations. However, accurately identifying eligible DSH patients and patient days requires aggregating large, disparate data sets and following strict CMS rules and reporting requirements to realize this revenue.

TransUnion Healthcare’s Medicare DSH solution addresses these challenges by automating DSH log preparation and providing a fully transparent view of a hospital’s DSH reimbursement opportunity. By leveraging the unique processing and data integration capabilities of our STINGRAY™ platform, hospitals can confidently and efficiently identify allowable DSH days versus non-allowable DSH days.

Historically, our proprietary process has increased Medicare DSH recoveries by up to 25% over internal efforts while maintaining an average 98% audit success rate. With our automated process, clients have found more than $506K in additional Medicare DSH recoveries per fiscal year, on average.^a

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

Maximizing reimbursement for complex Medicare payment issues requires leading-edge 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 TransUnion Healthcare to identify reimbursement opportunities missed by other vendors.

To maximize their Medicare DSH recoveries, hospitals should choose a partner with a deep understanding of complex and data-intensive cost report issues, as well as expert knowledge of ever-changing state-specific regulations. A DSH partner should perform multiple Medicaid eligibility matches to ensure that retroactively granted eligibility is captured before audit.

Partners should also be able to provide flexible delivery options. Our clients can choose to outsource their Medicare DSH 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 DSH log prep and recovery process.

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

To ease implementation pain, a Medicare DSH partner should communicate upfront what data is needed to complete a project, be available and responsive when clients have 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 implementation, training on how to use the platform and a full team of client service, project management, operations and technical staff to ensure success.

Quick Facts

• 11 years on the Short List
• 100% of peer reviewers would recommend TransUnion Healthcare’s Medicare DSH service to a colleague

Footnotes

a) Based on historical client results.

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