The Medicare cost report has been Strategic’s central focus since its founding nearly 50 years ago. We have the knowledge and experience necessary to ensure compliance with the regulations and to recover all reimbursement that the provider is entitled. Consistent with our philosophy, we will not simply send you a request for information and file the reports from a distance. We believe that it is necessary to spend time on-site interviewing your department heads and understanding the current environment of your organization. This will ensure the cost report reflects actual operations and your total reimbursement is reflective of the care provided to your Medicare beneficiaries. The cost report is critically important even if you are not a cost reimbursed provider. It is used to develop your cost to charge ratios that impact PPS payments, Medicare wage index, DRG costs weights, and may also be viewed by external stakeholders who want to learn more about the impact your hospital has on the community.
Strategic views the Medicare Disproportionate Share (DSH) add-on payment as a complex solution that isn’t focused entirely on the level of Medicaid days and the SSI percentage. Instead, we recognize the level of uncompensated care costs, and 340B eligibility, are critical components to consider too. The shift in the DSH add-on payment to focus more on uncompensated care than on Medicaid eligibility for hospitals serving low-income patients is significant. It is also a major focus for the Medicare Administrative Contractors during audit. Strategic will not only ensure that all eligible days are captured, validated, and maintain the appropriate documentation, but we ensure that every opportunity to qualify for uncompensated care payments and the 340B drug savings program are also pursued.
Strategic has an experienced team dedicated to providing a comprehensive approach to preparing or reviewing the hospital’s Traditional, Cross-Over, and Charity Medicare Bad Debts logs. In an environment where Medicare Administrative Contractors (MAC) across the country are enforcing more stringent requirements for hospitals to demonstrate reasonable collection efforts and requiring large amounts of documentation, Strategic’s process ensures accurate logs in accordance with the Medicare regulations and MAC requirements. Our team has extensive experience working with MACs across the country helping our clients meet the evolving procedural requirements necessary to ensure proper Medicare Bad Debt reimbursement.
Accurate reporting of wage and benefit related information on your cost report impacts a significant amount of Medicare payments for PPS hospitals. If your reported average hourly wage is trending lower than the rest of the country, you will receive less reimbursement for the same services year over year. Even small inaccuracies can result in the loss of hundreds of thousands of dollars in reimbursement. Strategic does not just review your hospital’s wages, benefits, contract labor, and home office information in a vacuum. Our review incorporates benchmarking and best practices that includes a comparison of your hospital’s wage index data to other hospitals in your Core Based Statistical Area (CBSA) and other CBSAs throughout the country. Under this approach, we will determine if your reported labor information is consistent with your competitors, and in line with rising labor costs across the country. We encourage hospitals to collaborate with other hospitals in their CBSA to form a consistent approach in reporting wage index data to maximize the CBSA’s wage index factor. Strategic specializes in bringing all the hospitals together to take a comprehensive approach to wage index with the goal of benefiting everyone. As part of every engagement, Strategic will also determine if your hospital, or possibly your entire CBSA, should reclassify to another CBSA or if you qualify for urban to rural redesignation.
Every three years, Medicare requires hospitals to file an Occupational Mix Survey (OMS). The calculations, underlying reporting, and use of the OMS is often misunderstood, and the impact of this adjustment is often significant. Strategic assists our clients with a thorough review of all Occupational Mix data to ensure they are not inappropriately penalized for staffing your units with the right mix of clinicians. Unlike most other consultants, Strategic will review your OMS each year to a assess whether any adjustments are applicable.
Strategic Reimbursement will take the time that your staff may not have to provide a comprehensive square footage report of your facility including all the documentation required by the Medicare Administrative Contractors (MAC) and others. Using the hospital's updated blueprints and/or CAD drawings, Strategic will prepare a report measuring every square foot of your facility. Our approach will be consistent with CMS requirements and the square footage identified on the blueprints will be cross-referenced to every department in your general ledger. With many overhead departments utilizing square footage as a statistical basis, accurate departmental square footage assignments are imperative to achieving proper reimbursement and maintaining a compliant cost report.
It is becoming increasingly difficult for hospitals to recruit experienced reimbursement staff to oversee the constantly changing, and complex reimbursement environment most hospitals and healthcare systems face today. More and more clients are seeking longer-term assistance with the management and operational aspects of a reimbursement department, from staffing during busy seasons to interim leadership. Strategic has the experience and perspective to meet this demand. Many members of the Strategic team have lead reimbursement departments, been part of large systems' operational and financial teams, or served as chief financial officers. We currently serve several hospitals and large health systems in a variety of Interim Director of Reimbursement roles.
Our focus in the capacity of an Interim Director of Reimbursement is not just the completion of routine work, but also the organization’s mission, supporting senior leadership, internal and external audit support, month-end and year-end close processes, contractual allowances, and third-party reserve reporting. Our interim services are a spectrum of services that will constantly evolve to meet your needs. Time without proper reimbursement departmental leadership can be costly, we will help mitigate any problems and ensure a smooth transition when you're ready.
Increasingly complex and ever changing federal and state healthcare laws and regulations have resulted in an array of litigation reaching as far as the United States Supreme Court. Provider Reimbursement & Review Board (PRRB) and Medicaid agencies continue to make navigating the avenues to resolution, whether through appeal agencies or judicial review, a challenging task.
Strategic has a dedicated team to help.
Over the past 40 years, Strategic has successfully guided hundreds of hospitals through this process. We not only work on large national appeals, but also individual hospital appeals that are typically resolved through administrative resolution.
We will not only help you identify all areas that should be appealed, but also help you thought-out the entire process ensuring all necessary procedures are followed to protect your appeal rights. We will take care of the filings, manage the deadlines, pursue administrative resolutions, and retaining legal counsel with a commitment to be at your side from the initial request for hearing, until you receive proper reimbursement.
Now more than ever, hospitals need to document and support all the charitable work they do each day. With the federal policy changes arising out of the Accountable Care Act (ACA), Hospital’s Disproportionate Share payments are now predominately based on a hospital’s level of uncompensated care costs (charity and bad debts). The reporting requirements placed upon hospitals to document their uncompensated care costs (UCC) is putting a strain on many hospital’s resources.
Strategic has a designated UCC team to monitor CMS’s evolving interpretation of UCC costs, guidance on reporting, and help navigate our clients through the challenging CMS audits. Specifically, we have developed a proprietary work plan that involves not just the finance team, but also patient billing, and IT/decision support to ensure the proper policies and procedures are in place to meet audit standards for acceptance. Strategic will bring you peace of mind that your uncompensated care costs are accurately identified, appropriately documented, and ready for audit.
As legislation and regulations change and become more complex, it is increasingly important for hospitals to frequently revisit internal policies and procedures as well as reassess their hospital’s compliance with current provisions.
Changes made to regulations may jeopardize Medicare reimbursement and result in penalties, such as, but not limited to:
Having guidance from industry experts in Medicare and Medicaid reimbursement while performing these needed internal reviews provides your institution with the best level of security for maintaining a healthy third-party reimbursement program. Our involvement with hospitals across the country, in all spectrums of reimbursement, makes us perfectly suited to provide you with this guidance.