Medicare and Third Party Services

Strategic Reimbursement was founded in 1975 primarily to assist hospitals with their Medicare reimbursement issues. Thirty years later, our Medicare services, defined as anything related to or stemming from the Medicare Cost Report, still constitutes the backbone of our firm. A sample of our main Medicare-related services are as follows:

Medicare Cost Report Preparation and/or Review Services

Strategic Reimbursement was founded in 1975 to assist hospitals in preparing their Medicare and other third party Cost Reports. Thirty years later, our Medicare Cost Report preparation/review services remain one of our core product offerings. While the advent of PPS has changed the reimbursement impact of the Cost Report, proper preparation remains vital in order to ensure compliance and maximize reimbursement. Please see our presentation "Yes - Your Cost Report Still Matters."

Strategic Reimbursement's consultants have an average of over 20 years experience preparing and reviewing Medicare Cost Reports. Utilizing CMS approved software and our proprietary Compliance Checklist, the Cost Reports we prepare for filing have passed all of the ever changing CMS edit checks with Fiscal Intermediaries across the country.

Finally, as part of our Cost Report services, we provide clients with feedback in the form of a Management Report that reviews and comments on all aspects of the reports and offers guidance and suggestions for the facility's third party program.

Medicare Disproportionate Share Hospital (DSH) Analysis and Verification

Leaving money on the table has never been a good approach to financial management. However, if you have not carefully considered the need for a comprehensive review and documentation of Medicaid eligible days, you have likely done exactly that!

Strategic Reimbursement has been actively assisting hospitals ensure maximum reimbursement through the Medicare DSH program for over fifteen years. The success of our DSH program can be attributed to a close working relationship with hospital personnel, as well as a professional respect and cooperation with the fiscal intermediary. Currently, SRI performs current year DSH calculations as well as prior year audits for missed days. We have achieved a high level of success in both. The intermediaries have accepted approximately 98% of the eligible days that we requested in current year calculations and for prior year audits. To date, Strategic Reimbursement's DSH efforts have resulted in payment to our clients of over $100 million dollars of additional Medicare DSH reimbursement.

Prior Year Medicare Cost Report Reviews - Medicare Compliance/Recoupment Program (MCRP)

Medicare regulations allow any hospital to re-file their Medicare Cost Report up to three years after the final Notice of Program Reimbursement (NPR) to correct any material errors. For over twenty five years, Strategic Reimbursement has been assisting hospitals review their "open" Cost Reports from a compliance standpoint and to realize any reimbursement to which they are legitimately entitled.

With an average of over twenty years experience, our consultants are intimately familiar with the Medicare regulations and are experts in finding missed reimbursement. To date, we have helped our clients realize hundreds of millions of dollars in missed reimbursement. Does an outside firm prepare your Cost Reports? Some of our largest recoveries were from Cost Reports prepared by outside firms. This is because many outside firms, especially large accounting firms, use junior consultants with minimal senior attention. At Strategic Reimbursement, we do not have any junior consultants. Every person who looks at your Cost Report has an average of 20 years of experience.

We provide this service on a contingency basis so there is no-risk to your hospital. Why not give us a call so that you can be sure that your Cost Reports are in compliance and that you have received all of the reimbursement to which you are entitled?

Provider Reimbursement Review Board (PRRB) Appeal Services

From the beginning of the Medicare Program, the disallowance of reimbursement by the Intermediary has resulted in the appeal of Cost Reports to the PRRB. Strategic Reimbursement has had extensive experience in every stage of the appeal process, having represented clients on countless issues. Strategic Reimbursement is capable of handling the full range of an appeal, or to consult on any specific aspect of an appeal such as the identification of issues, the filing of initial requests for Board hearing, the preparation and filing of preliminary and final position papers, or in providing expert testimony.

Strategic Reimbursement, when appropriate, will also form group appeals on behalf of it clients. We handle the full scope of the review, retaining legal counsel when necessary. Please click here to learn more about our two outstanding group appeals:

1. SSI Ratio
2. Outpatient Part B Blending

Wage Index Reviews and Geographic Reclassifications

Accurately reporting the wage data for your facility and your entire CBSA is vital to ensuring your facility's healthy financial performance. Given the zero-sum nature of Medicare's wage index modifiers, you must ensure that your data is accurate or risk losing millions of dollars in revenue. Strategic Reimbursement can help you and/or your entire CBSA ensure you report the proper wage index data. While we perform this service as a standard course of business when we prepare a Medicare Cost Report, we also perform this service independently. Therefore, our consultants have extensive experience verifying wage index data. Over our history, we have worked with numerous individual hospitals and entire regions to verify their wage index data. Why let your hospital or region loose money to other areas, when Strategic Reimbursement can help you accurately report your wage index and earn the money you are entitled to?

Medicare Bad Debt Compilation Reviews and Audit Assistance

Currently being reimbursed at 70% of the uncollected amount, the preparation of the Medicare Bad Debt Logs and a review of the procedures used in the recording of Medicare bad debts remains one of the surest ways to improve Medicare reimbursement. Our consultants will work with your patient accounting personnel to close the documentation gaps and reduce the audit reductions that you have experienced, and at the same time provide education and awareness that will benefit reimbursement in future cost reporting periods.

Reimbursement Department Management

We can provide your health care facility with the outsourced expertise that you need by supplying experienced personnel on an "as needed" basis to supplement your financial management team. Strategic Reimbursement will help in monthly closings and in year end contractual allowance and third party reserve analysis. Our experience often allows for a faster financial audit that can save you money. Strategic Reimbursement can be available as temporary help or on an on-going basis. Why hire a full time reimbursement director if all you need is periodic assistance?

Area Assignment Studies

With regard to square footage studies, Strategic Reimbursement can take the time that your staff doesn't have to provide the auditable detail that Intermediaries and other auditors require. Using the hospital's updated blue prints or CAD drawings, we provide referenced summaries that measure every foot of your facility and report the data on a consistent basis for every department in your general ledger. With depreciation and plant operation expenses being so large, up to date area assignments are an absolute requirement for an accurate and compliant Cost Report.

IRIS File Preparation and Review

Teaching hospitals of all sizes have used our services to help in the preparation of accurate GME and IME resident FTE counts. Whether used to augment available staff or to supply missing expertise, Strategic Reimbursement is ready to assist your facility in this important task. We will check for missing rotations, review for proper documentation and outside agreements, and correspond as necessary with affiliated teaching hospitals to make sure that this substantial source of Medicare reimbursement is not understated.

Budgeting, Financial Forecasts and Feasibility Studies

With our "hands on" experience in recording and accounting for hospital expenses in a wide range of client facilities, we can provide the independent expertise you need to evaluate and budget for both new services and existing services. Our expertise in third party payment and cost accounting is a natural asset for the successful completion of these special projects.

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Managed Care Services

Strategic Reimbursement began consulting on managed care related issues in 1995. Since that time we have assisted numerous hospitals receive maximum reimbursement from this often difficult class of payors.

Illinois Blue Cross UPP Reconciliation and Verification

Strategic Reimbursement and the Metropolitan Chicago Hospital Council (MCHC) have teamed up to offer the Blue Cross Blue Shield of Illinois Managed Care Compliance/Recoupment Program. Due to the unique and complex nature of Blue Cross of Illinois's claims adjudication and payment process, hospitals cannot compare the payments they receive through the normal billing/accounts receivable process. Therefore, this program is designed to help ensure hospitals receive full and proper reimbursement, from Illinois Blue Cross. The program includes the following features:

• A retrospective review of account and payment activity
• The identification of both "under" and "over" payments
• The recovery and tracking of "under" payments
• Specialized staff education and training
• No cost assessment review
• Contingency based fee at no risk to the hospital

Please click here to learn more about the partnership between Strategic Reimbursement and the Metropolitan Chicago Healthcare Council.

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