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Teaching hospitals are required to create a "shadow claim" in order to receive Indirect Medical Education (IME) / Graduate Medical Education (GME) payments from Medicare when the patient is enrolled in a Medicare Advantage plan. Shadow billing is a persistent problem for teaching hospitals as Medicare's methodology places the burden upon the provider to identify Medicare Advantage IME claims and code the affected claims correctly before processing. Not capturing 100% of all eligible accounts negatively impacts IME revenue and ultimately affects the facility's ability to reconcile and maximize GME through the cost report. HPS has reviewed over 180 teaching hospitals
HPS conducts retrospective reviews and retroactive reimbursement to the beginning of the timely filing period for IME/GME reimbursement. There are too many changing variables to identify, track and effectively manage eligibility and payment manually. Frequently, Accounts Receivable may not be set up to track shadow billing. So HPS developed Stingray to automate these processes, which is 30-60 times faster than manual or screen scraping techniques. Market Distinction: HPS has done more IME/GME reviews than any other service company with 150 reviews in 2010. On average, we have found an additional 30% over the initial provider effort. Stingray automation enables us to review 500,000 records a day with uncanny precision |
Teaching hospitals are required to create a "shadow claim" in order to receive Indirect Medical Education (IME) / Graduate Medical Education (GME) payments from Medicare when the patient is enrolled in a Medicare Advantage plan.