Medicare Shadow Billing Guide
Medicare shadow billing is the process of submitting no-pay claims to Medicare for services provided to Medicare Advantage (Part C) patients, ensuring encounters are recorded for IME, DSH, and cost reporting. While reimbursement comes from the Medicare Advantage plan, shadow billing is crucial in revenue cycle management to secure supplemental Medicare payments, optimize future funding, and support accurate risk adjustment and cost reporting. This process helps validate utilization data, ensuring providers maximize reimbursement opportunities and maintain compliance with Medicare regulations.
IMPORTANT: Shadow billing only operates on inpatient claims. You must have the inpatient checkbox checked and a DRG present in coding.
Configuring GoRev for Medicare Shadow Billing
Configure carriers AND Plans
To activate automatic shadow bill generation navigate to Insurance Carrier Management
Click on a Carrier, click into the Claim Generation tab, and check the box next to Medicare Shadow Billing Required
To activate only specific plans and not all plans linked to a specific carrier navigate to Plan Management
Click on an insurance plan's row, scroll down in the General tab, and check the box next to Medicare Shadow Billing Required.
Configure your Medicare Carrier
Navigate to Insurance Carrier Management
Locate your Medicare carrier (where you want shadow bills generating to) and click its row. Make sure the claim filing indicator is set to MA - Medicare Part A or MB - Medicare Part B. These are the two indicators the shadow bill system will look for and use to select your specific Medicare carrier.
Teaching hospitals
Navigate to Admin --> Configuration --> Locations
Check on the box Teaching Hospital. This will configure the shadow billing system to add an additional condition code of 69 onto the no bill shadow claims.
Add Medicare benefit info during registration
Your registration process will need to be changed in order to collect the patient's Medicare benefit information along with their primary insurance managed Medicare info.
This only needs to be done ONE time using the Managing Known Insurance Plans module.
Click into Manage Insurance from within Patient Overview.
Click New.
Add the Medicare benefit information and click Save Changes
You should now see both the managed plan and Medicare
IMPORTANT: You should not add Medicare as an actual payer on the visit. If you do this a real claim will be filed to Medicare. You should only see your Managed insurance plan.
Releasing Shadow Claims in Batching
A new column is now present in claim batching titled "Medicare Shadow Bill" if you see a checkmark in this column it indicates this row is for the no bill shadow claim.
You will also need to keep an eye out for new redline batching errors.
If you see:
You need to visit Manage Insurance and add the patient's Medicare benefits (see guide above)
Additional Resources
GOREV SUPPORT TEAM
If you have any additional questions or concerns regarding this tutorial, please contact the GoRev Support Team by phone at (317) 794-3900 or by email at
Note: Always submit an IT Support Ticket detailing the problem that you are experiencing with this portion of GoRev, if possible, as this will give GoRev Support Agents access to information that will help expedite the resolution of your issue. If you are unsure how to submit an IT Support Ticket in GoRev, please see the GoRev IT Support Ticket Creation Tutorial for assistance