Medicare Bad Debt
Unparalleled Research
HPS is a research driven consulting firm and one of our core competencies is scouring the publicly available data for reimbursement opportunities. Recently, we completed a Medicare bad debt study based on publicly available cost report information available from CMS (roughly 58,000 Medicare cost reports.) We have analyzed each hospital’s specific Medicare Bad Debt cost report information and compared it with local, state and national averages. Using this study, we can quickly tell you how you stack up against other providers in your area and give you an estimate of how much additional reimbursement you are entitled to. Simply let us know which hospitals you’d like to be compared with and we’ll get back to you in a few days with a customized analysis.
Proprietary Software
Copays and Deductibles are often low dollar, high volume accounts. Due to the sheer volume of accounts it can be easy to miss some of these in the MCBD claiming process, especially during a manual audit. However, these low-balance accounts can add up to hundreds of thousands of dollars in MCBD claims for hospitals. We have developed proprietary software (AccuTrack) to address this concern. Accutrack, powered by Microsoft SQL Server, aggregates and reconciles potentially millions of lines of patient data from different sources in a fraction of the time it would take during a manual review. This allows us to investigate more data in less time and uncover more money for you.
- Complements providers’ internal efforts by starting with your Detailed PS&R data
- Utilizes our Accutrack software to Review 100% of your deductibles
and coinsurance - Ensures that all proper collection activity has been completed and documented
- Prepares pre-qualified and audit-ready bad debts logs
- Provides complete and timely audit support
DSH is one of the last areas of the Cost Report that continues to provide significant Medicare reimbursement opportunities for your facility. Fortunately, HPS has the experience and technology to help you maximize your reimbursable DSH dollars.
Proprietary Software
HPS uses proprietary DSH technology that is able to analyze and verify patient eligibility line by line to generate the maximum number of eligibility days for use in your facility’s Cost Report. HPS’ proprietary software even contains a powerful algorithm that methodically and accurately links the ever troubling "newborn" and "parent" data together. The result to you is increased eligibility claims with maximized reimbursement. You can be assured that as the financial steward of your organization, you will not be leaving any reimbursable dollars on the table.
What about documentation and support for the DSH eligibility claims?
It is no secret that providers are often denied potential DSH payments because the required documentation is incomplete, missing from the submission or altogether non-compliant. You can be confident that HPS will take care of your documentation issues as well. Items such as Eligibility codes, share of costs, Aid Codes, EVC numbers, etc…, are recorded and stored with each patient record. Subsequently, and in most cases, we are able to generate the documentation and work papers that can verify, categorize, support, and even calculate slight nuances of every data element contained in your submission that we provide to CMS. On top of this supporting documentation, HPS is even able to produce a standard set of reports that are FI tried and proven.
HPS reviews transfer DRG’s for Medicare and other DRG based payors to determine if the DRG based payor inappropriately paid less than the full amount due the hospital.
Using proprietary software and audit processes, 100% of transfer DRGs are reviewed and those with a potential reimbursement impact are identified, analyzed, and rebilled as appropriate. Experience to date indicates that roughly 1%-3% of transfer DRGs has been incorrectly underpaid. At approximately $2,000 per claim, this amounts to between $40,000 and $120,000 per year for a hospital having just 2,000 DRG based discharges in a year. In some cases, we are able to correct underpayments for up to three to four years. It should be noted that CMS and its fiscal intermediaries have an audit process in place to identify overpayments they have made. It is the responsibility of the individual provider to identify underpayments.
Reviews are performed offsite with minimal information required from the client.
Volume Decrease AdjustmentHPS works with Sole Community Providers (“SCP”) and Medicare Dependant Hospitals (“MDH”) that experience a decline of more than five percent in total discharges, due to circumstances beyond their control, to qualify for a pass-through Volume Decrease Adjustment from Medicare. HPS works with hospital staff to confirm that the decrease in volume resulted from a qualifying event that had a direct impact on admissions and a substantial cost effect. HPS’s review ensures that adjustment amounts include the reasonable cost of maintaining necessary core staff and services along with a number of other requirements for a Volume Decrease Adjustment.
HPS has experienced reimbursement and cost accounting professionals with significant hospital administration and finance backgrounds that can assist providers to determine if they qualify for a Volume Decrease Adjustment. HPS’s staff work offsite to prepare all the documentation necessary to collect reimbursement for a Volume Decrease Adjustment.
Tricare (CHAMPUS)HPS is the leading provider of Tricare payment reviews in United States. There are a number of niche issues within the Tricare space that HPS alone has identified and recovered for healthcare providers. To date, HPS has recovered more than $30,000,000 in additional reimbursement from the Tricare/CHAMPUS program for their hospital clients. HPS personnel interact daily with Department of Defense and Tricare/CHAMPUS Fiscal Intermediary personnel and are intimately familiar with the Tricare/CHAMPUS reimbursement regulations. No other consulting firm has the depth of experience and expertise in this area of reimbursement.
Medicare Transition Outpatient PaymentHospitals subject to the Outpatient Prospective Payment System (“OPPS”) may have been eligible for a transition outpatient payment (“TOP”) under Regulations at CFR 419.70. Except for certain classes of hospitals, these payments were for services rendered between 8/1/00 through 12/31/03.
Our research team just completed a review of TOP calculations for this period of time for every hospital in the county. Based upon this research, we are working with several providers to recover additional reimbursement for one or more reporting periods during the time period above.
