BC Advantage - 2011 Issue 3

Medicare Advantage Shadow Billing: Are Providers Leaving Entitled Monies on the Table

This issue of IMA Insights seeks to provide a comprehensive discussion of "shadow billing" by hospital providers for their Medicare Advantage enrollees, focusing on the reimbursement and compliance implications that need to be considered. While information has been published either through government sources or through articles published in the healthcare arena, little is available that ties together the various facets of shadow billing.  This lack of clear and detailed guidance should come as no surprise to the provider community. CMS is well aware that hospital providers have left millions of dollars on the table and they are in...

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