Medicare Advantage claims and IME

It is my understanding that claims for MA patient inpatient admissions are submitted to the MA plan but also a "informational only" claim is submitted to the MAC with appropriate condition codes and comments and that claim results in the payment of IME money directly from Medicare. My questions-
Does this also include DSH and uncompensated care payments?
If the MA plan denies or otherwise 'downgrades' the claim, does the hospital have to submit a corrected claim to the MAC? For example, if the MA plan disallows an MCC and pays the DRG with a CC, the amount of IME money would drop since that amount is in proportion to the total DRG amount. But how does the MAC know the MA plan disallowed an MCC?


  • Does this also include DSH and uncompensated care payments? 

    No, only the Operating IME is paid on the MAC claim; this amount is also Transfer adjusted.  Also, the requirement is that all MA inpatients need to have shadow claims submitted to Medicare--this can include Distinct Units, CAHs, and other types of inpatients that would not actually receive IME payments--they would receive a 0.00 payment from the MAC.

    I do not think I have seen anything from my MAC or CMS addressing your other questions. 
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