Our Services

Reimbursement Strategy

 

Reimbursement rules and regulations are constantly in flux. Keeping up with change is challenging. Staying ahead is nearly impossible. We can help you stay abreast of recent developments along with their impacts and develop strategies for continued reimbursement success.

  • Updates to Medicare and Medicaid rules and regulations are complex and confusing. We can help cut through the clutter to identify and quantify changes affecting your organization and to develop strategies to help optimize or mitigate the impact of those changes.

  • Choosing the most advantageous geographic classification requires complex modeling and an understanding of MGCRB and CMS guidelines. We can help with individual or group reclassification and redesignation analyses and filings.

  • Provider payment classifications can have a material impact on hospital reimbursement. We can help determine the most beneficial payment classification strategy for your organization, including Rural Referral Center, Medicare Dependent Hospital, Sole Community Hospital, Low Volume Adjustment, Critical Access Hospital and Rural Emergency Hospital.

  • As mergers and acquisitions have become more common, we have developed solutions to analyze the cost report during the due diligence process. For newly acquired facilities, we can help identify potential reimbursement opportunities or concerns. We can also assess the reimbursement implications of new hospitals in home office cost reporting and the realignment of services across providers.

Reimbursement Services

 

Balancing daily responsibilities with governmental reporting requirements can be stressful. Achieving full reimbursement potential while maintaining compliance with rules and regulations is difficult. We can help with the following:

  • Medicare, state and TRICARE reports are complex annual reports requiring significant resources to complete properly. We can assist with cost report preparation, review, audit, reopenings and appeals.

  • Wage index data reporting is a critical driver of Medicare payments to your facility and other facilities in your labor market. We have conducted hundreds of wage index optimization projects for individual hospitals, health care systems, labor markets and hospital associations. We have developed a detailed, data-driven approach to identify opportunities for data refinement.

  • Medical education reimbursement is complex and time consuming. We provide assistance with intern and resident counts, IRIS reporting, available bed counts, affiliation agreements and resident redistribution applications.

  • Medicare Disproportionate Share (DSH) is a key component of hospital reimbursement. Hospitals qualifying for DSH also qualify for Uncompensated Care Payments and may qualify for the 340B drug discount program. Correctly identifying Medicaid eligible patient days is essential to qualifying for and optimizing DSH payments.

    We have developed a comprehensive, data-driven approach to identify patient days eligible for inclusion and have the ability to run Medicaid eligibility in most states. We can also analyze the data used in the SSI percentage to determine the underlying data accuracy and the most appropriate period for reporting.

  • Uncompensated care reporting on Worksheet S-10 requires detailed analysis of patient data and adjustments. Associated audits are very detailed and time consuming. We can assist with the preparation and reporting of data on Worksheet S-10 and provide audit support.

  • Medicare reimbursement for bad debts requires thorough analysis of patient payment and account activity to ensure proper reporting. We can provide assistance with the preparation of bad debt logs at the time of filing or via retrospective reviews. We also assist with development and implementation of policies and procedures consistent with Medicare guidelines.

  • Medicaid Disproportionate Share reporting requires vast amounts of data analysis. We have developed models to assist with this process for the initial filings or subsequent audit requests.