MEDICARE/MEDICAID

Medicare/Medicaid reimbursement enhancement services help providers optimize their reimbursement from these government programs.

Disproportionate Share Hospital (DSH) Analyses – Medicare and Medicaid

The Medicare and Medicaid Disproportionate Share Hospital designations provide many hospitals with additional reimbursement for indigent care and other programs. Improperly reported information may lead to loss of funding from these programs. Draffin Tucker assists hospitals related to Disproportionate Share Funding. We work closely with state regulators to remain current with rules and filing procedures. In addition, we help hospitals identify eligible Medicaid days to maximize their ability to participate in such programs, as well as the filing of surveys and plans that regulatory agencies require.

Medicare & Medicaid Reimbursement

Medicare and Medicaid reimbursement can be among the most complex and critical issues healthcare providers face. For more than 45 years, the professionals at Draffin Tucker have provided for the unique reimbursement needs of Home Health Agencies, Hospitals, Skilled Nursing Facilities, and other healthcare providers in the area of Medicare and Medicaid reimbursement. Since 1967, the first year of the Medicare program, we have filed cost reports for healthcare entities and currently prepare more Medicare cost reports for submission, with fewer resulting intermediary audits, than any other firm in this service area. We are familiar with many alternatives to maximize reimbursement under the Medicare and Medicaid programs and know the related documentation required by intermediaries. With a thorough understanding of the relationship and impact of the Medicare and Medicaid programs, we are uniquely qualified to assist your facility.

Medicare Critical Access Hospital Designation

Many small rural hospitals benefit from gaining Medicare Critical Access Hospital cost-based reimbursement. The improved reimbursement has given new life to many of these hospitals. We assist your hospital in pursuing Critical Assess Hospital designation, accomplished by performing the financial analysis of CAH designation, provide reimbursement and billing, consultation, and cost report preparation.

Medicare Geographic Reclassifications

Reclassification may allow your hospital to obtain increased Medicare funding due to the higher wage index and standardized amounts used in funding determination for inpatient and outpatient payments. Draffin Tucker provides consultation and assistance to providers in reclassifying to another area for the Medicare wage index and standardized amounts.

Medicare Provider-Based Requests

Provider-based facilities often receive greater reimbursement than free-standing facilities. Regulators require proper organization and operation to approve provider-based status. Effective development and organization of provider-based requests are essential for quick approval and avoidance of cash flow delays. Draffin Tucker provides consultation and assistance to providers in substantiating Medicare provider-based status of related entities. Such assistance includes completing provider-based requests, developing and organizing supporting documentation, and liaising with state, federal, and fiscal intermediaries.

Medicare Rural Referral Center Applications

Medicare Rural Referral Center status can increase inpatient Medicare reimbursement for qualifying hospitals. Hospitals may also benefit from favorable treatment in Medicare Geographic Reclassification determination. Draffin Tucker provides assistance in preparing the Rural Referral Center request with the development and organization of supporting documentation. We also serve as a liaison with the Medicare Administrative Contractor (MAC) regarding the request.

Medicare Sole Community Hospital Applications

Medicare Sole Community Hospital status benefits many hospitals by receiving improved reimbursement, however, hospitals must be at least 25 miles from similar facilities. We can help your hospital prepare the Sole Community Hospital request by developing and organizing supporting documentation. We also act as the liaison with the MAC regarding the request.

Medicare Wage Index Reporting and Reviews

Reporting inaccurate wage index data can be a costly mistake. Errors can substantially impact reimbursement and may even be viewed as compliance deficiencies. Wage data reported on the hospital's Medicare cost report is used to calculate a significant portion of the payment for inpatient, outpatient, inpatient psychiatric, inpatient rehabilitation, skilled nursing facility, hospice, and home health services.

We can help you with every step of the wage index process: from compiling all the relevant data for inclusion on the cost report and occupational mix survey to detailed analysis of the supporting documentation to ensure data is complete and accurate, to reviewing and requesting corrections to the public use files before the data is used to calculate your payments.

Merger & Acquisition Reimbursement Consulting

For many healthcare providers, the ever-changing payment environment has caused organizations to evaluate their position in the marketplace. With lower payments per service unit and more value-added requirements, many healthcare providers are considering either merging with larger providers or acquiring smaller providers to retain economies of scale within their marketplace. These organizational changes result in significant regulatory, compliance, accounting, and reimbursement challenges and opportunities. These challenges and opportunities must be planned and supported with the full knowledge of experienced personnel and consultants.

TRICARE Capital and Direct Medical Education Cost Reimbursement

Hospitals subject to the TRICARE/CHAMPUS DRG-based payment system are eligible for additional reimbursement for allowed capital and direct medical education costs. The professionals at Draffin Tucker can assist you in submitting the required request for reimbursement necessary to obtain the additional funds.

Additional Services