Case Study: Midwestern Not-for-profit Medical System achieves $2.1 million in recovered Medicare underpayments with TransUnion

Clients Recover Medicare Underpayments from Incorrectly Coded Transfer Patient

A large Midwestern not-for-profit medical system needed help finding Transfer DRG reimbursement opportunities hidden among thousands of patient accounts, where incomplete or incorrect data was causing Medicare underpayments and overpayments. TransUnion supported the internal reimbursement team with its STINGRAY™ screening and review service to identify claims affected by Medicare’s Post-Acute Care Transfer Policy.

TransUnion’s automated analysis reviewed 100% of the relevant patient population, reconciled records with the Medicare Common Working File, and added specialist and quality control reviews to validate non-conforming claims. The process helped the medical system recover $2.1 million in underpaid Medicare claims over five years, required 0 hours of business office resources, and was completed in just three weeks.