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Reimbursement

How does your organization stay up to date with new regulation and changes in the reimbursement landscape? How do you improve care and reduce costs?

Our team of reimbursement professionals—including CPAs, former hospital controllers and reimbursement managers, ex-Medicare auditors, and more—provides leading-edge reimbursement services to some of the most prominent hospital systems in the country. Our professionals stay up to date on regulatory changes and help clients save millions of dollars in reimbursement opportunities each year.

Who we serve.

We work with a wide variety of healthcare organizations, including hospitals, skilled nursing facilities, continuing care retirement communities, home health agencies, Rural Health Clinics (RHC), and Federally Qualified Health Centers (FQHC), and more.

Services Overview

  • Medicare/Medicaid cost reports
  • Medicare cost report adjustment review and appeals
  • Medicare bad debts
  • Medicare disproportionate share
  • SSI consulting
  • Medicaid disproportionate share
  • Leveraging programs and supplement payment reviews
  • Self-pay reviews
  • 340B consulting
  • Wage index and occupational mix reviews
  • Managed care contract reviews
  • Interns and resident consulting and analyses
  • Mergers/acquisitions – reimbursement impacts
  • Feasibility studies
New Requirements by Humana for 340B Participants

New Requirements by Humana for 340B Participants

Attention 340B covered entities participating with Humana – Managed Care Medicare: Effective January 1, 2019, Humana requires that a “JG,” “TB,” or another relevant modifier be added to claims involving 340B eligible outpatient drugs under the Medicare Outpatient Prospective Payment System (OPPS) with status indicator “K.” If a claim does not include the proper modifier […]

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U.S. District Judge Rules 340B Cuts Exceeded HHS Authority

U.S. District Judge Rules 340B Cuts Exceeded HHS Authority

On December 28, 2018, a federal judge in Washington reversed the enormous cuts to Medicare OP Drug payments implemented by CMS which were effective January 1, 2018. U.S. District Judge Rudolph Contreras ruled CMS and HHS secretary exceeded their authority by cutting 340B reimbursement by approximately 28.5%. The Medicare OP Drug reimbursement methodology for certain hospitals […]

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Leveraging 340B Compliance to Improve Profitability

Leveraging 340B Compliance to Improve Profitability

Compliance is often a misunderstood word that most healthcare professionals associate with spending more time and money. Typically, compliance is defined as a certification or confirmation that the doer of an action or manufacturer of a product meets the requirements of accepted practices, legislation, prescribed regulations, specified standard or terms of a contract. 340B Program […]

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Connect with our team.

To learn more about our reimbursement services, contact our team here.

Send us a message.