Reimbursement and payment advisory services

Maximize your reimbursement potential

Use reimbursement as a strategic tool and drive financial success

In today’s high-cost environment, a strategic approach to reimbursement is essential. Our experts help you navigate the complexities of Medicare, Medicaid, and third-party payments, relieving financial stress and ensuring you capture every eligible opportunity.

With extensive experience optimizing reimbursement opportunities, we leave no stone unturned, giving you peace of mind that your financial strategies are in capable hands. We focus on incremental revenue shifts to benefit your entire system and maintain high-quality patient care without compromising your bottom line. By collaborating closely with your team, we develop tailored reimbursement optimization plans that promote long-term financial success and empower you to make confident financial decisions. Partner with us and transform your financial future today.

August 14, 2024

Health system margin pressures persist

Hospitals and health systems are seeing operating margins stabilize. Yet many healthcare organizations struggle to reclaim lost margins, and rising costs are poised to outpace Medicare adjustments. These four strategies will help you build a path to financial stability.

Article / 6 min read Read more

Reimbursement and payment advisory insights

Health professional explaining Medicaid redetermination.

November 06, 2023

Optimize your 2025 reimbursement strategy. Watch on demand: “Navigating changes to Medicare regulations.”

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Going beyond cost report preparation

Our range of Medicare and Medicaid reimbursement consulting services

Cost report preparation & review

Our reimbursement team completes more than 1,200 cost reports each year. We understand that cost reports mean more than the current-year settlement. When reviewing a facility’s cost structure, we look for opportunities and weigh all related consequences. We’ll compile your cost reports using our proprietary Plante Moran Reimbursement Optimization Model™, which ensures accuracy and consistency across your enterprise. We’ll look for opportunities impacting the current-year settlement and future rate setting and assist with adjustment and interim rate reviews.

Medicare DSH optimization

Our Medicare DHS optimization service helps you fully utilize the cost-saving and reimbursement options that are available. We deliver 3A-compliant reports that provide deep insight that can serve as a foundation for proactive decision-making. These reports reveal how changes in payor mix, Medicare SSI percentage, 340B Drug Pricing Program Implications, Worksheet S-10 Uncompensated Care Reporting, or service lines could impact reimbursement and/or 340B Drug Discount Program eligibility.

Medical education reimbursement

Medicare funding is essential to sustainable medical education programs. Whether you’re an established academic medical center or considering hosting medical students for the first time, you need a partner who understands the intricacies of medical education reimbursement regulations and the key cost report drivers of your reimbursement. We’ll help you meet complex challenges, including interns and resident listing reviews, affiliation agreement assistance, available bed day reviews, and show billing analyses.

Medicare wage index

Wage index and wage reclassification are vital to securing your hospital’s financial health, yet hospital wage index reporting is complex. Using our proprietary comprehensive Medicare wage index data modeling tool, Leading Edge™, we incorporate publicly available wage data, geographic mapping, and financial impact analysis into one technology solution. This data-driven approach quickly and accurately evaluates all possible scenarios and delivers the optimal benefit for wage index opportunities such as wage index reviews, wage reclassifications, and occupational mix.

Medicare bad debt

Medicare policy allows for the partial reimbursement (currently 65% of allowable bad debt) of Medicare coinsurance and deductible amounts that remain unpaid by the beneficiaries or other responsible third parties. The rules and regulations based on these criteria are complex, and hospitals must ensure they’re receiving the full amount they’re entitled to while being able to support the amounts claimed for reimbursement properly. In collaboration with our technology partner, our team can provide and include the Medicare bad debt listing in your filed cost reports.

Reimbursement strategy

Hospitals can significantly enhance their reimbursement strategy by ensuring regulatory compliance with Medicare and Medicaid, streamlining revenue cycle management, and leveraging data analytics to identify inefficiencies. Our reimbursement consultants help financial leaders transition to value based care models and develop customized reimbursement optimization plans. This comprehensive support helps hospitals improve cash flow, maximize reimbursement, and maintain financial stability while providing high-quality patient care.

IPPS reimbursement is complex. Our complimentary hospital-specific IPPS rate impact report details what you need to know.

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Healthcare leaders count on us for better outcomes

With over 80 years of experience, our experts understand new and emerging issues impacting your reimbursement allowing your organization to provide the high-quality patient care to the communities you serve while not compromising your organizations bottom line.