Shadow claims refer to claims hospitals submit to their Medicare Administrative Contractor (MAC) for inpatient services provided to Medicare Advantage beneficiaries. These claims are submitted to request supplemental payments for Indirect Medicare Education (IME), Graduate Medical Education (GME), and Nursing Allied Health Education (NAHE). Unfortunately, the information needed for shadow claims is often missed, resulting in hundreds of millions of uncollected revenue each year.

OUR SOLUTION
Indirect Medicare Education (IME)
Shadow Claims

• Our proprietary software identifies shadow claims that were not submitted for IME

• We provide beneficiary eligibility and necessary claim information necessary for billing

• Detailed management reports facilitate real-time tracking of reimbursement

• Our detailed review process uncovers unbilled shadow claims for non-teaching hospitals

• We provide new registration procedures, employee education, and billing system modifications

• A complete roadmap to help mitigate future regulatory changes impacting shadow claims

Results

Our solutions identify claims eligibility that ordinary search processes miss. On average, we uncover 3-5% of unbilled IME claims with revenue averaging $1K per claim.

Experience

Our consulting staff is highly experienced in the realm of finance, reimbursement, compliance, and revenue cycle management. With over 25 years of direct healthcare experience, we identify areas beyond what other solutions offer.

Value

We provide value to our clients by offering limited interruption to staff making the project as seamless as possible. All the while, we provide a high-quality deliverable.