Medicare and Medicaid Cost Reimbursement

Successfully optimizing compliant Medicare and Medicaid cost reports can be challenging, especially with continuously evolving federal and state regulations. Further, incorrect data filed in the cost report can have substantial unintended consequences and threaten financial distress to hospitals. Health care providers are tasked with comprehending complex, multifaceted legislation and applying it for optimal reimbursement on an ongoing basis—a challenge to sustain while maintaining efficient operations.

Our professionals manage reimbursement issues for all types of health care organizations including large health care systems, rural hospitals, critical access hospitals, skilled nursing facilities, home health agencies, and rural health clinics. By doing so, we have deep expertise and insight into how to efficiently prepare data for cost reports—an understanding that’s difficult for organizations to obtain when only performing these tasks annually with limited resources.

Our professionals:

  • Prepare cost reports for submission to Medicare Administrative Contractors (MACs) and state-specific reports such as OSHPD and Medi-Cal (California), YEC (Alaska), HMSA (Hawaii), and DMAP (Oregon)
  • Prepare Medicare Disproportionate Share Hospital calculations for cost report submissions
  • Prepare and optimize Worksheet S-10 data for cost report submissions
  • Prepare and optimize Medicare bad debt logs
  • Act as a liaison with MACs and state agencies to help resolve cost report issues
  • Support you with Medicare, Medicaid, and Medi-Cal audits, including preemptive services such as pre-audits and consultations
  • Develop strategies for the successful arbitration of appeals and re-openings of issues related to finalized cost reports
  • Prepare Medicare position papers related to appeals filed with the Provider Reimbursement Review Board
  • Assist with Office of Inspector General and MAC investigations regarding Medicare services
  • Formulate third-party reserves for financial-reporting purposes
  • Analyze monthly contractuals
  • Assist critical access hospitals in capturing appropriate reimbursement for services and performing interim settlement analyses
  • Support hospitals with federally qualified health clinic (FQHC) and rural health clinic (RHC) billing and reimbursement issues
  • Train staff on billing and coding issues and help establish or revise billing for services to improve compliance with government regulations
  • Assist with interim reimbursement management and routine reimbursement department functions
  • Assist with due diligence support
Perform wage index reviews

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