Services

Transfer DRG Review

HPS reviews transfer DRG’s for Medicare and other DRG based payors to determine if the DRG based payor inappropriately paid less than the full amount due the hospital.

Using proprietary software and audit processes, 100% of transfer DRGs are reviewed and those with a potential reimbursement impact are identified, analyzed, and rebilled as appropriate. Experience to date indicates that roughly 1%-3% of transfer DRGs has been incorrectly underpaid. At approximately $2,000 per claim, this amounts to between $40,000 and $120,000 per year for a hospital having just 2,000 DRG based discharges in a year. In some cases, we are able to correct underpayments for up to three to four years. It should be noted that CMS and its fiscal intermediaries have an audit process in place to identify overpayments they have made. It is the responsibility of the individual provider to identify underpayments.

Reviews are performed offsite with minimal information required from the client.

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