GRT / SOLUTIONS

Targeted recovery.
Claim by claim.

Focused technology and reimbursement expertise for hospital CFOs and revenue cycle leaders working through complex underpayment and Medicare reimbursement opportunities.

BUILT FOR HOSPITAL CFOs + REVENUE CYCLE TEAMS

INSURANCE PAYER TARGETED REVIEW

Find underpayments hidden across payer methodologies.

GRT applies purpose-built, payer-specific analytics across hospital claim populations to identify potential underpayments based on contract terms and reimbursement methodologies. Experienced reimbursement auditors validate each finding and support recovery through the appropriate correction, appeal, or payer-resolution process.

Targeted detection. Expert validation.

Purpose-built, payer-specific analytics identify potential payment discrepancies. Experienced auditors validate findings and support recovery through the appropriate resolution path.

01Query

Apply targeted logic across claim populations.

02Flag

Surface potential underpayment hits for review.

03Validate

Auditors determine whether the claim was underpaid.

TRANSFER DRG

Recover full DRG reimbursement when transfer logic says it is due.

Automation identifies claims paid under per diem methodologies that may qualify for full DRG reimbursement under Medicare’s Transfer Rule or applicable commercial payer contracts. Experienced analysts validate each finding, and GRT can rebill the claim with the payer and track it through payment.

PAYER ENVIRONMENTS — Medicare, Medicare Advantage, and applicable commercial contracts can create transfer or per-diem payment opportunities that require claim-level validation.

01Identify

Automation finds per diem-paid claims that may qualify for full DRG reimbursement.

02Validate

Experienced analysts confirm eligibility and reimbursement logic.

03Rebill

GRT can rebill validated claims with the payer.

04Track

Follow the claim through payment.

IME / DGME

Identify claims where IME / DGME teaching reimbursement was missed.

GRT identifies Medicare Advantage encounters with potentially missed IME / DGME teaching reimbursement so the opportunity can be validated at the claim level and prioritized for recovery.

PAYMENT PATHS — the Medicare Advantage claim may be paid while the separate Medicare teaching-payment claim is never generated, rejected, or left unresolved.

MA CLAIM

Billed to Medicare Advantage → Paid by the MA plan

IME / DGME CLAIM

Separate Medicare teaching-payment claim → May never be generated, may reject, or may remain unresolved → Potential recovery opportunity

MEDICARE ADD-ON PAYMENTS (NTAPs)

Find potential missed NTAP reimbursement.

GRT reviews account-level and charge-level data to identify qualifying technologies, confirm the required claim coding, and determine whether Medicare’s add-on payment was included and calculated correctly.

VALIDATION POINTS — the qualifying technology, required claim coding, and Medicare payment calculation must align before the add-on payment opportunity can be confirmed.

01 Identify

Surface claims and charge detail involving technologies that may qualify for an add-on payment.

02 Validate

Confirm the technology was used and that the required claim coding supports the payment.

03 Compare

Compare payment with and without the qualifying code to determine the incremental reimbursement opportunity.

START WITH THE CLAIMS

See where reimbursement is being left behind.

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