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Reimbursement

The ability to obtain appropriate, optimal payment for services provided in the healthcare industry is often directly contingent on a provider’s ability to pro-actively manage its payer contracts and reporting obligations.

For many years the healthcare industry has experienced severe reductions in operating margins on services provided. As a result, it is more important than ever to ensure your organization has a robust and systematic approach to managing all aspects of your various reimbursement streams.

CRI’s healthcare professionals have considerable experience and expertise in assisting our clients in enhancing reimbursement. Among other services, our professionals help with:

  • Cost reporting related advisory services (including, but not limited to, S-10 improvements for reporting uninsured costs, Wage index for both occupational mix and improvement, Medicare bad debt reimbursement improvements, geographic reclassifications such as urban to rural for improving teaching program reimbursement, SSI review and Medicaid patients for Medicare DSH improvement, and expert testimony in regulatory appeals)
  • Business office performance review and assistance focusing on the revenue cycle aspects
  • Payer contract profitability reviews and renewal negotiations
  • Assistance with cost report desk reviews and audits*
  • Ensure appropriate modifiers are applied to reimbursement by transferring DRG reviews for acute care hospitals
  • Monitoring LTACH critical points including Average Length of Stay, site-neutral payments, payment-to-cost ratios for outlier reconciliation

We provide value-added services to healthcare providers of all types and sizes, designed to meet expectations in the current environment and prepare for challenges ahead.

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