Medicare Advantage Shadow Billing: Don't Leave Money Behind For Your Sub-Units
Category: Billing
Hospitals actively involved in an accredited teaching program are entitled to supplemental payments for the reimbursement of medical education costs associated with treating Medicare Advantage (MA) patients. To receive the medical education payments for these patients, an information only, or "shadow" bill must be submitted.
Frequently, a portion of these payments is overlooked at teaching hospitals that have active psychiatry and/or rehabilitation sub-providers because these sub-units are not eligible for Indirect Medical Education (IME) payments. However, psych and rehab sub-units are eligible for Graduate Medical Education (GME) payments and should be shadow billed not only to remain compliant, but also to ensure the hospital receives all monies to which it is rightfully entitled. "Shadow billing", synonymous with "no pay" or "information only" claims, is an unof...
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