Teaching payments. Recovered beyond the MA claim.
GRT identifies Medicare Advantage encounters where IME or DGME teaching-payment reimbursement may have been missed, then validates eligibility, claim generation, and rejected-claim issues.
Identify Medicare Advantage encounters where IME / DGME teaching payments were missed.
The Medicare Advantage claim and the Medicare teaching-payment claim follow different paths. GRT identifies encounters where the separate IME or DGME payment may not have been generated, paid, or successfully resolved.
The MA claim and the Medicare teaching payment follow different paths.
MBI not captured
The Medicare Advantage encounter is in the hospital system, but the Medicare identifier needed for the separate teaching-payment claim may be missing or inaccurate.
IME claim never generated
The Medicare Advantage plan is billed and paid, but the corresponding Medicare teaching-payment claim is never generated.
Eligibility identified later
Medicare Advantage eligibility can be updated after discharge, after the normal billing workflow has already moved on.
Rejected claims fall out of the process
A teaching-payment claim can reject for an eligibility or patient-identification issue without affecting payment of the underlying Medicare Advantage claim.