Healthcare Reimbursement Partners LLC provides services to a wide range of clients, including for-profit and not-for-profit providers, cost-based and prospectively paid providers, and large teaching hospitals and critical access hospitals.
- Preparation – Filing a complete and accurate cost report is critical to ensuring the accuracy of provider reimbursement. Not only are cost reports used for purposes of calculating various Medicare and Medicaid reimbursement settlements, but they are also used by various federal and state governmental agencies, educational and public policy institutions, and news organizations to draft policy and law, formulate provider reimbursement rates, determine eligibility for government programs (i.e., 340B, MDH/SCH designations, etc.), and develop studies and media reports on hospital operations and results. Our professionals apply a standardized preparation methodology, critical thinking, attention to detail, and analytical processes to ensure accuracy and compliance. We provide these services to a wide range of provider types, including the following:
- Acute Care Hospital
- Critical Access Hospital
- Long Term Care Hospital
- Inpatient Psychiatric Hospital
- Inpatient Rehabilitation Hospital
- Skilled Nursing Facility
- Home Health Agency
- Rural Health Clinic
- Home Office
- Review – For those providers who have their own staff or contractor preparing the cost report, we will review the completed cost report and supporting workpapers to validate compliance as well as apply analytics to validate reimbursement, explain historical cost reporting trends, and identify potential reimbursement issues.
- Audit Support – Filing the required cost reports is only the first step in obtaining reimbursement due to the provider. We offer audit support that includes fielding questions and information requests from the Medicare Administrative Contractor.
Our team has experience both completing the various forms of state Medicaid DSH and UC applications as well as completing the standardized audit templates used for the mandatory state audits. Our methodology applies analytical tools, comparative analysis, and reasonableness checks to ensure the data is accurate and complete.
We assist providers with the documentation, calculation, and drafting of appeals for protested items and disputed audit adjustments
Our team has a deep knowledge of cost report preparation and reimbursement issues and applies a systematic approach to reviewing current and prior year cost reports for more accurate reporting. In some cases, the issues we identify result in additional reimbursement due to the provider, which must be obtained through the filing of a cost report reopening. In addition to drafting the reopening request, our team can work through our Medicare Administrative Contractor contacts to shepherd the request through the audit process.
Medicare Disproportionate Share Hospital (‘DSH’) and Rehabilitation Low Income Patient (‘LIP’) programs reimburse providers that serve a disproportionately high percentage of low income patients. We assist providers with identifying and documenting all qualifying Medicaid eligible days to accurately compute the DSH and LIP reimbursement on the Medicare cost report.
The square footage statistic is used by many providers on the Medicare cost report to allocate overhead costs, including depreciation, plant operations, maintenance, and housekeeping. New construction, building renovation, opening of a new unit or a significant time lapse since the last square footage survey are all good reasons to have a square footage survey completed. Most healthcare providers believe square footage studies are only for Medicare cost-based providers such as CAH’s; however, with the incorporation of Worksheet S-10 uncompensated care costs into the Uncompensated Care payment calculation and the use of Medicare cost data in the calculation of Medicaid DSH reimbursement, the accuracy of square footage statistics are becoming more important. With the assistance of architectural drawings and provider facilities staff, we complete a detailed survey of your facility, including on-site and off-site locations, that accurately measures the square footage by location, room, department, and Medicare cost report department.
As part of the methodology for determining prospective payments to hospitals, CMS annually calculates a geographic wage adjustment factor based on a collection of hospital wage data. We assist providers in the review of their Medicare cost report wage data during the Wage Index audit to ensure all allowable salary, contract labor, and wage related cost and hours are identified and successfully incorporated into the audited wage index data.
CMS collects data every 3 years on the salaries and hours of several categories of nursing and other personnel and adjusts the geographic market average hourly wage for differences in provider staffing decisions. Our professionals work with provider staff to identify and categorize all salaries and hours to timely submit an accurate and compliant survey.
Claiming the unpaid Medicare patient deductible and coinsurance requires a significant amount of policy and process coordination. Our team can coordinate with the provider business office, accounting, and management staff to review bad debt collection policies, bad debt write-off accounting processes, and Medicare bad debt logging practices to ensure all allowable amounts are being documented and claimed on the cost report. These reviews often lead to the identification of additional Medicare bad debt reimbursement and can also minimize audit adjustments.
Generally, Cancer Hospitals and Children’s Hospitals are reimbursed a portion of cost up to a hospital-specific TEFRA cost ceiling. Adjustments to the cost ceiling may be requested by providers in the event the operating cost structure has materially changed from the previous base year used to calculate the TEFRA cost ceiling. We can assist providers with analysis to determine whether there is merit to an adjustment request and can draft all request transmittals and documentation required to justify a TEFRA cost ceiling adjustment.
Hospitals paid under IPPS may request a reclassification from their geographic Core Based Statistical Area (CBSA) to a higher wage area CBSA for purposes of receiving a higher payment if they meet certain average hourly wage and proximity requirements. Our professionals can determine whether the provider qualifies for a geographic reclassification as well as assist with filing the request to the Medicare Geographic Classification Review Board.
When a Medicare patient is discharged from a hospital to a post-acute care setting, the hospital is paid a prorated DRG payment (or Transfer DRG). If the patient does not actually obtain post-acute care services as instructed, then the hospital is entitled to the full DRG payment from Medicare rather than the prorated payment amount. Our team can identify these claims, obtain support and document the claim underpayments, and provide a listing of claims for rebilling.
Effective for Federal Fiscal Year 2018, CMS initiated the transition to begin using Worksheet S-10 uncompensated care data along with Medicaid days and SSI days for purposes of calculating the distribution of Uncompensated Care pool funds to providers. We believe that CMS intends to eventually calculate the Uncompensated Care payment amounts using only Worksheet S-10 uncompensated care data. Our professionals can perform a comprehensive review of the provider’s bad debt, charity, and financial assistance policies as well as analyze the financial data used to report charity care charges and bad debt write-offs to ensure accurate Worksheet S-10 reporting and Uncompensated Care payments.
Changes to provider cost structures or charges can result in significant changes to provider or distinct part unit cost-to-charge ratios (CCR’s) and increased outlier payments. When the change in the Medicare CCR and the amount of outlier payments exceeds certain CMS thresholds, providers may be subject to an outlier reconciliation or essentially a recoupment of outlier payments. We can assist providers who may be subject to an outlier reconciliation with cost report reviews to ensure cost and charge accuracy, analysis of the potential outlier recoupment, and develop arguments for appeal.
For providers looking for assistance to determine whether there may be additional reimbursement or ways to improve cost report settlement accuracy, our team can complete a top-to-bottom review of Medicare, Medicaid, and TRICARE program cost reporting and reimbursement using prior year cost reports and client workpapers. Our methodical approach can identify both operational and reimbursement process improvements as well as cost reporting revisions needed for accuracy.
Our seasoned professionals can assist clients in their legal proceedings as expert witnesses by bringing to bear years of healthcare reimbursement expertise and coordinating with legal counsel to provide supporting documentation, present the case and testify on behalf of the client.
Our team can assist providers with determining whether certain departments or sub-units (i.e., Home Health, SNF, Psych, Rehab, etc.) are profitable using a combination of cost reporting data and internal data.
Critical Access Hospital (CAH) Conversion Analysis
For clients considering conversion to a CAH, our team can determine the potential future government payer reimbursement implications of the conversion as well as generate a historical impact analysis for purposes of identifying and explaining trends that could identify conversion risks or benefits in the future.
Acquisition Due Diligence
We offer a full review of current and historical government programs reimbursement based on cost reporting data, target provider due diligence data requests, and CMS published information that identifies potential acquisition risks, transition issues, and operational and reimbursement process improvements.
Medicare/Medicaid Settlement Accrual Analysis
Our professionals can conduct a top-to-bottom review of all historical and current settlement accruals to determine whether adjustments should be made to the general ledger settlement accounts.
Medicare/Medicaid Provider Enrollment Filings
Provider Enrollment Revalidations
Medicare periodically requires providers to revalidate their enrollment data and may withhold payment or even deactivate Medicare billing privileges if the revalidation is not submitted. Our team can monitor CMS published information to ensure no revalidation deadlines are missed as well as assist the provider with all of the required filings to maintain compliance.
Change of Ownership (CHOW)
Both Medicare and Medicaid require providers to report certain transactions that are considered CHOW’s. If proper planning is not taken or the appropriate Medicare and Medicaid filings submitted, significant interruptions in cash flow. Many of our clients involve us early in the transaction process to assist with transitioning from the previous to new owner and to ensure timely and accurate CHOW filings.
We assist institutional providers with their enrollment form submissions to their Medicare Administrative Contractor to ensure a smooth on boarding with Medicare.
Change of Information
Providers enrolled with Medicare are required to report certain changes, including location, ownership, chain office, billing agency, Authorized Official, and Delegated Official information. Let our team assist you with the filings required to notify Medicare of these changes.
Provider-based Attestation Filings
While a voluntary filing with the Medicare Administrative Contractor, we encourage clients who have undergone a change of ownership or who have new provider-based entities to submit provider-based attestations if there is a reimbursement impact between billing as a provider-based or freestanding provider. This filing increases the provider’s assurance that all regulations are being met and may limit any payment recoupment should the provider not meet all provider-based requirements.