Medicare Managed Care – Teaching Hospitals
In order to obtain indirect medical education and direct medical education add-on payments from Medicare for the Managed Care inpatient stays, the hospital must bill the inpatient claim to Medicare. Most teaching hospitals do not identify all of the eligible Medicare Managed Care claims creating opportunity loss in the form of lower Medicare IPPS payments which are settled through the cost report.
PFC provides clients periodic reviews of the potentially unbilled claims. We provide these services in a timely manner, in most cases allowing teaching hospitals to submit the claim within the Medicare submission statutes. PFC may also be able to help Teaching Hospitals retroactively identify and claim previously unbilled or unprocessed Managed care IME claims.