Reducing the Adverse Impact of Medicare Audits:

The Importance of Getting It Right the First Time

In recent years, Medicare Administrative Contractors (MACs) have become more restrictive regarding cost report reopenings. This is a major challenge, as many hospitals have adopted reopenings as a standard operating procedure to correct cost report submissions from prior years.

Why MACs Are Cracking Down on Reopenings

In the past, hospitals were allowed to request a reopening anytime they needed—as long as they complied with relevant CMS regulations. This placed a substantial administrative workload on the MACs.

In early 2016, several of our clients notified us that their reopening requests were denied by one particular MAC. Since then, multiple MACs have adopted stricter criteria for allowing cost report reopenings. With a clear trend emerging, hospitals are under more pressure than ever to ensure that they submit accurate and complete initial filings.

Healthcare Payment Specialists Chief Product Officer John Garcia discusses the
importance of capturing quality data across the entire hospital organization.

Obviously, hospitals have always wanted to submit accurate initial cost reports. No one working in a busy hospital reimbursement department wants to go through the process of reopening or amending a cost report months or years after the initial submission. But given the volume of coding and paperwork related to Medicare and Medicaid claims, it’s always been difficult to ensure 100% accuracy. The challenge is amplified for revenue executives at larger health systems with multiple facilities and multiple systems.

There are multiple places where errors arise in the cost report preparation process. Historically, the dependence on manual data entry has been a source of errors. While the digitization of medical records and hospital revenue cycle processes has helped reduce the likelihood of clerical mistakes, hospitals have been confronted with the massive increase in complexity driven by the change from ICD-9 to ICD-10 and the need to integrate data from multiple systems and sources.

Reducing the Adverse Impact on Your Hospital’s Revenue

Receiving optimal reimbursement requires a focus on data governance and integrity across the entire organization. If data capture and reporting is incomplete or inaccurate, or simply not done in a timely manner, the adverse impact on reimbursement can be substantial. However, it can be a challenge to navigate all of the disparate data sources inside and outside of the hospital, and correlate all of the relevant data points—especially under a tight deadline.

Many hospitals have invested in technology and built out processes to aggregate the necessary data for preparing cost reports. However, there is also a need for reimbursement teams to work with stakeholders in other departments throughout the hospital to ensure that everyone understands the impact of their activities on total reimbursement.

Healthcare Payment Specialists is focused on helping hospitals improve the quality of cost reports so they can ensure maximum reimbursement in today’s stringent regulatory and auditing environment. Our STINGRAY™ platform provides critical business analytics for the hospital revenue cycle, enabling our clients to:

  • Identify and prioritize claims and encounters most likely to result in suboptimal reimbursement
  • Automate the review process to find missed revenue faster
  • Optimize reimbursement for key payment issues
  • Get future cost reports right the first time

Ready to learn more? Contact us for more information.

Healthcare Payment Specialists

Healthcare Payment Specialists

Founded in 2002, Healthcare Payment Specialists (HPS) provides technology enabled solutions for health care eligibility, government reimbursement and compliance to hospitals and healthcare systems across the country. Using its STINGRAY software platform, HPS delivers solutions on a software-as-a-service (SaaS) basis or through outsourced service engagements.
Healthcare Payment Specialists