Shadow Billing Solutions
Medicare Advantage plans do not make payments for indirect graduate medical education or nursing/allied health education costs. Instead, hospitals are required to submit a separate bill (referred to as a "shadow bill") to the Medicare administrative contractor (“MAC”) in order to receive these payments from the Medicare program.
Many times, these shadow bills are overlooked, or not properly billed to the MAC. When this occurs, providers fail to capture critical reimbursement, including important “days” that could negatively impact other Medicare payments.
Fortunately, SunStone's has a proprietary process that is effective at identifying Medicare Advantage claims that have not been submitted to the Medicare program for payment This is one more way we help you realize valuable revenue and save valuable time.
SunStone’s process is thorough, quick and creates virtually no burden on staff. Depending on your needs, the reviews may be performed on a standalone basis, or in tandem with a Transfer DRG Analysis.
WHY IS THIS THE BEST SOLUTION?
SunStone brings you tremendous reimbursement and revenue cycle experience. With our professional consultants, you enjoy the knowledge that your consultants are well respected in the industry and are working hard to determine all the revenue you are due while being in compliance with governmental guidelines and regulations.
WHAT OUR CLIENTS SAY
Our clients recognize that even though they have an internal process for identifying and submitting shadow bills, that no one captures everything. They appreciate having a credible firm provide a comfort level that all claims are identified and appropriate revenue is being captured.
PART OF AN EVEN LARGER SOLUTION
Our Shadow Billing services are often provided in tandem with a Transfer MS-DRG analysis.