Reimbursement & Revenue Enhancement

Our Reimbursement and revenue enhancement services add substantial value to hospital and nursing home healthcare providers through our demonstrated abilities to analyze, project and optimize reimbursement revenue streams. The Freed Maxick Healthcare team can uncover underpayments and streamline process to improve the fiscal health of the organization. Check out our available services:

Services for Hospitals

Medicare Disproportionate Share—We assist providers that serve high numbers of Medicaid and Medicare SSI patients to optimize Medicare DSH reimbursement. This service evaluates the traditional DSH calculation and the uncompensated care portion of the computation. Typical results, for traditional DSH, identify 1% -3% additional Medicaid eligible days that translates into $200 – $400 per day in revenue. In addition, we assist with optimizing the uncompensated care portion of the DSH calculation.

Medicare Wage Index—We have significant experience assisting groups of hospitals with increasing their average hourly rate for wage index reporting. The scope includes comprehensive review of the underlying accounting data used for wage index reporting. Accounting systems are not designed for this type of reporting which creates inaccuracies in reporting and typically understates the average hourly rate. Our services typically increase the average hourly rate by 1% -5% which equates to millions in Medicare reimbursement.

Medicare Bad Debts—We provide optimization services that increase Medicare bad debt revenue and provide supporting documentation for Fiscal Intermediary audits of this area.

NYS Bad Debt & Charity Care Reporting—We help hospitals increase their bad debt & charity care pool distributions by identifying additional patients that qualify for the nominal need calculation and the units of service methodologies. We can perform a diagnostic assessment to estimate potential value that could be achieved.

NYS Disproportionate Share Cap—We provide services to properly report estimated Medicaid and uninsured losses that establish pool distribution caps for all hospitals (i.e., pool distribution cannot exceed DSH Cap amount). We have assisted hospitals with obtaining their entire pool distribution when their preliminary DSH Cap falls below the pool distribution.

For public hospitals that qualify for Inter-government transfer (IGT) payments, we have successfully used this methodology for optimizing their IGT payments. Our IGT projects typically deliver millions in incremental IGT revenue.

Services for Hospitals and Nursing Homes

Cost Report Assessment—The Medicare and Medicaid cost reports have a high degree of complexity and require expertise to optimize Medicaid and Medicare reimbursement. Our cost report assessment service performs a diagnostic review that identifies reimbursement opportunities that translates into incremental revenue.

Cost Report Preparation—With our in-depth reimbursement expertise both from the Fiscal Intermediary and provider perspectives, we provide assistance with preparing Medicare and Medicaid cost reports. Our clients find this as a cost effective approach to hiring internal expertise.

Reimbursement Retainers—We provide a scope of reimbursement services for a specific period of time (usually yearly contracts). Services may include cost report reviews, review of Medicare final settlement, net revenue analysis, third party settlement calculations, review of Medicaid rate sheets etc. Our clients find this as a cost effective approach to hiring internal expertise.

Reimbursement Department Outsourcing—Perform reimbursement management services for clients where we become internal management and deal with day to day operations of the department.