In order for a teaching hospital to receive Indirect Medical Education (IME) payments when the patient is enrolled in a Medicare Advantage plan, hospitals are required to create a supplemental “IME claim.” This requires capturing a patient’s Medicare number at admission, a step that is missed more often than one would imagine. When mCare finds an unbilled IME event, we provide the information that enables the hospital to prepare and submit the IME claim.
Non-teaching hospitals are also required to submit information only claims for Medicare Advantage discharges. These "shadow claims" contribute to total Medicare utilization statistics used by CMS to calculate funding for the hospital. VHC identifies these unbilled shadow claims for non-teaching hospitals.