Revenue Enhancement

Healthcare companies across the country lose millions of dollars in reimbursement each year. Even with a highly trained reimbursement staff, Medicare’s complex, ever-changing laws, regulations, and instructions can be overwhelming. The following are a few proven revenue enhancing services we provide to healthcare facilities across the country.

Wage Index and Geographic Reclassification  

Wage index is one of the most important sections of the Medicare cost report and is often over-looked. Wage index data is used to adjust Medicare payments for acute care hospitals. Not only does a hospital's wage index data effect their own hospital payments, but also has a direct impact on all acute care providers within the same geographic area. Even the slightest increase in a hospital's wage index can result in thousands of dollars in additional reimbursement. Our process includes a detailed analysis of total salaries, hours, contract labor, wage related costs, and occupational mix surveys.

Graduate and Indirect Medical Education (GME/IME)

GME and IME payment rules are based upon a complex set of Medicare regulations that require an in-depth knowledge of the hospital's various programs and how each program should be reflected on the Medicare cost report.


You must submit a completed Interns and Residents Information System (IRIS) data file with your cost report. We typically perform the following steps:       

  • Review residency rotation schedules
  • Compile FTE listings
  • Check for missing rotations
  • Review for proper documentation
  • Review offsite rotations
  • Review weighting criteria
  • Review prior year and penultimate year FTE counts 
  • Review beds available for compliance with current instructions
  • For first year GME programs, we review GME costs paid as a pass through cost on the cost report and assist in determining the base year PRA

Medicare Bad Debts (Medicare Part A and Managed Care) 

Healthcare providers lose millions of dollars in bad debt reimbursement due to non-compliance with Medicare regulations and instructions. Medicare Bad Debts are created when a beneficiary fails to pay deductible and co-insurance amounts. 

 

Our automated process begins with the entire patient download to ensure adjustment codes are not overlooked. Each record is matched to the detailed Provider Statistical and Reimbursement report and scrubbed to ensure compliance with regulations including proper collection efforts. We have recouped millions of dollars in bad debt reimbursement for our clients over the past several years.

Disproportionate Share Hospital Payments (DSH)

DSH payments are a major component of hospital reimbursement and are often the focus of an intermediary review. The ever-changing DSH laws, regulations, and instructions are extremely complex and require detailed knowledge to accurately calculate reimbursement.

 

Our automated process begins with the hospitals entire inpatient claims volume and includes data normalization prior to eligibility verification and validation. Our process is proven and stands up to audit! Your hospital may also benefit from an SSI percentage realignment analysis.