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DSHRIP | Medicare Disproportionate Share (DSH) Revenue Improvement Program

gds Transfer DRG


(TDRG) Solution

Each day GDS identifies and recovers Transfer DRG underpayments capturing much needed dollars for hospitals just like yours. Today is the day you can engage GDS to begin working effectively for you so you don’t have to work as hard or overpay for inferior results and service.

According to the Post-Acute Care Transfer Policy ("Transfer DRG"), an acute care hospital receives a prorated payment whenever a patient is transferred to a qualified Post-acute Care facility within the guidelines of the policy. In many cases however, the patient does not receive follow up care subject to the policy as initially intended, meaning the hospital is due the full Medicare DRG payment. Detecting TDRG underpayments in real-time is next to impossible. It’s estimated that 1-3% of Medicare fee-for-service discharges are misidentified as transfers and underpaid by Medicare.

GDS can effectively help you investigate and recapture lost Transfer DRG underpayments by:

  • Accurately identifying and reporting underpayments (and overpayments) resulting from Medicare transfer and post-acute care transfer policies.
  • Providing complete documentation, instructions, and full support for rebilling underpaid claims.
  • Continuously tracking adjustment claims through payment to ensure accurate reimbursement.
  • Providing billing support for resolving claims in RTP status.
  • Providing ongoing RAC audit support even after the project period has ended.

Our compliance-focused solution is among the most trusted in the industry. Relying on the Medicare Common Working File (CWF) alone will virtually guarantee improper coding and overpaid claims that bypass edits. GDS utilizes multiple data points and a staff of highly-trained professionals to call the intended post-acute care provider for every account in question. This should give both your executive team and business office staff complete peace of mind.

GDS has analyzed millions of claims for hundreds of hospitals to recover nearly 100 million dollars in Transfer DRG underpayments for claims dating back to Federal Fiscal Year 2005.

This service is also available for TRICARE, Medicare Advantage, and commercial claims.

Please contact us at (800) 370-7397 x101 to learn more or to get your free, no obligation demo of our Transfer DRG services.

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