The Top 4 Mistakes Hospitals Make When Capturing Data for Medicare Reimbursement

Capturing data properly can be the difference between obtaining all of the Medicare reimbursement your hospital is entitled to receive and suffering compliance errors or negative audit adjustments. Even when hospitals handle claims or bad debts correctly at the time, they can still end up losing reimbursements if they don’t properly archive relevant data sets and can’t produce that data years later in response to an audit.

The failure to manage data effectively causes substantial missed reimbursement opportunities. Since 2015, Medicare has taken back over $500 million in once-reportable Medicare bad debt. This staggering – and growing – number indicates one of two things for those hospitals that lost this reimbursement:

  1. They were out of compliance with the Medicare bad debt regulations at the time they filed their cost report
  2. They couldn’t provide enough data to support the listings on their initial cost reports upon audit

Preventing the loss of Medicare bad debt reimbursement can be achieved with the right technology and business processes. Hospitals can improve how they gather, collect, store, and retrieve data to avoid the Medicare auditing pitfalls that many other hospitals experience.

Healthcare Payment Specialists Director of Client Development Joe Gumbert explains four of the
most common data-capture mistakes hospitals make that result in lost Medicare reimbursements.

Mistake #1 – Not Planning Ahead for Audits

Patient and treatment data must often be retrieved multiple years after an initial filing – in fact, it’s not uncommon for hospitals to be required to dig up information that is over a decade old.  The growing number of patient accounting systems has made identifying the proper data even trickier. Switching to a new patient accounting system can be a major challenge to ensuring data availability. The key to success is to put in the effort required to ensure that your data is archived and warehoused in a way that it can be recovered easily in the future.

As it relates to audits by a Medicare Administrative Contractor, in order to support reimbursement under review, you’ll need to supply past remittance advices, charity applications as well as other data. The data might be years old and warehoused in a way that is hard to access, but you must be able to provide accurate information. Even if you originally put the analysis together correctly, you could receive a negative audit adjustment if you’re unable to assemble the proper data.

Mistake #2 – Failing to Comply with Regulations

When assembling its Medicare Bad Debt listings, a hospital must complete a number of required fields. If those fields aren’t aggregated accurately, there is a risk that an issue could be identified during an audit.

For example, if you can’t capture the correct remittance dates, write off dates, or dates to the patient, you’ll be at risk, which could lead to the exclusion of your entire bad debt listing.

Mistake #3 – Mismanaging Personnel and Data

Many hospitals struggle to get personnel with the right skills in the right place to get the job done. Revenue executives need to find the person or people who best understand the ins and outs of Medicare reimbursement—and have the ability to work with large and disparate data sets.

If you can put these individual in the right positions, your team will be in position to capture every reimbursement dollar that is owed to your hospital. The ability to communicate and work with various departments is also essential, because in addition to handling large quantities of important data, these personnel will be interacting with:

  1. The business office
  2. Patient financial services
  3. Collection agencies
  4. Outside Medicaid and Medicare programs

However, even the most talented and organized team of analysts and managers will have a limited impact without high-quality, accurate data that has been captured and stored properly.

Data that is cohesive, complete, contextual, and coherent will have the most mileage, so take a keen eye at how disparate data are being managed. We’ve seen many instances of data being retrieved from Medicare, Medicaid, or a collection agency in inaccurate ways. If the data set isn’t organized in a way that links relevant pieces of information together and communicates the data coherently, your reports will underachieve from a reimbursement perspective.

Mistake #4 – Using the Wrong Tool for the Job

Along with the right people, processes, and data, you’ll need the best technology to tie it all together. Using the wrong tools for the job can make otherwise strong data ineffective.

Many hospitals, for example, will be tempted to use Excel spreadsheets for making sense of reimbursement data. Others will use canned reports prepared by somebody on the IT team who might not fully understand how the data needs to be used—or the potential financial impact of any errors. You might not know what information is filtered out because all you see for sure is the result of those canned reports.

You need a platform that is not only up to date with current Medicare regulations, but also up to date with your databases and requirements of third parties in your reimbursement ecosystem. If you’re ready to do more to maximize your reimbursements and minimize compliance errors, contact Healthcare Payment Specialists to find out how our data-driven approach and deep experience enable us to deliver savings for hospitals nationwide.

Healthcare Payment Specialists

Healthcare Payment Specialists

Founded in 2002, Healthcare Payment Specialists (HPS) provides technology enabled solutions for health care eligibility, government reimbursement and compliance to hospitals and healthcare systems across the country. Using its STINGRAY software platform, HPS delivers solutions on a software-as-a-service (SaaS) basis or through outsourced service engagements.
Healthcare Payment Specialists