Financial Reimbursement Services

CBIZ financial reimbursement services analyze, project and optimize reimbursement revenue streams. The reimbursement team provides highly technical skills that uncover underpayments and improve the fiscal health of the organization. Common engagements include:

Medicare Reimbursement Services

Medicare Cost Report Review & Preparation

Medicare cost report preparation is regarded as one of the most difficult tasks to accurately complete in the necessary timeframe due to the complexity of the worksheets and the ever-changing regulations. Even the most experienced reimbursement professional can miss optimization opportunities that can leave valuable reimbursement dollars on the table. This complexity is compounded by many providers' inability to dedicate adequate resources to properly completing and reviewing the cost reports.

We have the technical skills to ensure that the Medicare cost report is optimally prepared. CBIZ offers hands-on cost report preparation, on-site progress review, staff support, completed cost report review and focused software support.

Medicare Cost Report Settlement Appeals

CBIZ consistently helps providers to obtain significant additional reimbursement by reviewing, reopening and appealing Medicare cost reports. Typically, the cost reports are reviewed after final settlement in order to identify errors or other opportunities to revise and resubmit the cost report and subsequently recover earned dollars. While every engagement is unique, many of CBIZ's clients have recouped hundreds of thousands of dollars and others have pending appeals worth much more.

Medicare Post Acute-Care Transfer (PACT) Services

CBIZ's PACT services enusre that providers capture all of their entitled PACT revenue. Our four-step approach provides hospitals with a comprehensive and thorough way to obtain their PACT-related revenue. The PACT services we offer include claim screening, discharge status validation, claim research and hospital approval. CBIZ will resubmit all claims, monitor processes through the Medicare Administrative Contractor (MAC) and track payment. Using CBIZ's approach, hospitals can feel confident knowing that CBIZ will be reviewing all of its PACT-related accounts, not just the high-dollar ones.

Reimbursement Opportunity Reviews

Our financial reimbursement services team will identify opportunities for increased reimbursement through the proper identification of costs, charges and variables within the cost reports. Examples of typical engagements include:

  • Disproportionate Share Hospital (DSH) Impact: CBIZ facilitates the exhaustive process of capturing all eligible Medicaid and charity care days to enhance the level of clients' DSH reimbursement.
  • Cost Studies: CBIZ provides selected Medicare cost Reporting cost studies for worksheet A-8 to optimize the allowable cost to the hospital. This service yields a significant competitive advantage to clients because most providers offset other operating income on this worksheet instead of performing the time consuming cost studies.
  • Wage Index: One of the most important and beneficial reimbursement enhancements is a thorough review of reported wage index data. CBIZ provides a full review of all detail information within the allowed timeframes, including full optimization and an accuracy review.
  • End Stage Renal Disease (ESRD) Review: Based on current Medicare regulations, hospitals that provide care to ESRD patients that equals or exceeds 10% of Medicare inpatients will receive additional Medicare reimbursement. CBIZ assists hospitals in quantifying the level of ESRD patients in their facility and attaining the qualifying threshold.
  • Outpatient Reimbursement: Ambulatory Payment Classifications (APCs) have drastically altered Medicare outpatient reimbursement for hospitals. CBIZ provides hospitals with extensive reviews of APC Medicare revenue. Our team uses internal data to map APC codes and highlight clinical and reimbursement deficiencies.

GME and IME Reimbursement Level Analysis

The Balanced Budget Act of 1997 states that hospitals may request supplemental payments for graduate medical education (GME) and indirect medical education (IME) costs for Medicare managed care enrollees. Beginning January 1, 1998, hospitals were eligible to receive 20% of these fees, which would increase each year by 20 percent to full payment of 100 percent by 2002. However, hospitals are only able to collect these amounts if separate billing is performed successfully with the intermediary. CBIZ will assume the responsibility to bill these accounts to Medicare, using the hospital's TP terminal.

Medicare Case Mix Index (CMI) Calculations

CBIZ will calculate the Medicare CMI by using data information supplied from the client's IS department or an outside vendor. CBIZ will extract the Medicare patients supplied from the data and group the payments by diagnosis-related groups (DRG) using the current weights. The Medicare CMI calculation excludes outlier payments. CBIZ can modify the data to include both the inlier and outlier payments to calculate an adjusted median CMI.

Medicare Inpatient Rate Verification

Each year, the Centers for Medicare and Medicaid Services (CMS) implements changes to the Medicare Prospective Payment System (PPS) rates. These changes include updates to the DRG operating and capital rates and modifications to the Medicare relative weights. The financial impact of these updates is significant because they affect the cost outlier threshold, Transfer case compliance and calculation of inpatient Medicare payments. In the past, fiscal intermediaries have been slow to update all of the PPS rates. Unfortunately, the burden is on the provider to verify that the fiscal intermediary has correctly incorporated all annual updates to the PPS rates and provided proper payment.

CBIZ has developed both a software product and hard copy report to assist our clients in verifying that the fiscal intermediary has properly updated the PPS factors. The software product (PPS 2008- VERIFYER) will allow you to calculate PPS rates instantly, and it is available in either Excel or Lotus 123 formats. Both products are presented in an easy to follow format for use as both a reimbursement and billing tool.

Medicare/Medicaid Revenue Projection

CBIZ maintains the current level of Medicare and Medicaid reimbursement for hospitals by adjusting their charges to compensate for changes in the cost outlier threshold and cost to charge ratio (CCR). For budgetary purposes, hospitals should quantify the level of charge increases needed to maintain the current level of Medicare reimbursement after changes in the cost outlier threshold and CCR. Based upon current Medicare case mix indices, CBIZ has the ability to calculate hospitals' projected Medicare inpatient revenue and provide a reconciliation to identify the reasons for the changes in reimbursement by issue.

Medicare Transfer Review

The determination of payment for inpatient hospital services under PPS differs depending on whether the patient is classified as a "discharge" or a "transfer." CBIZ performs comprehensive audits of the "discharge" versus "transfer" status re-coded on Medicare records to protect hospitals from Office of the Inspector General focused review non-compliance and generate correct Medicare reimbursement for the facility.

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Budget & Reimbursement Services

All-Inclusive Revenue Projection

CBIZ's all-inclusive revenue projection provides the anticipated 2008 net revenue for hospitals by modeling the impact of the following variables:

  • Medicare regulation changes related to the PPS, outpatient reimbursement, Tax Equity and Fiscal Responsibility Act (TEFRA) providers, home health, sub acute units and skilled nursing facilities
  • Managed care payers reimbursement, including rate sensitivity and medical denials
  • Medicaid HMO and DRG reimbursement
  • Charge based reimbursement

In addition, a sensitivity analysis is provided to quantify the impact of:

  • Charge level changes on collected revenue
  • Payer shifts in volume and mix
  • Revenue sensitivity to length-of-stay reductions
  • Decision support services

CBIZ provides hospitals with expert decision support services to analyze the impact of program growth, cost reduction efforts and payment scheme shifts on reimbursement. Past engagements have included:

  • Comparison of PPS DRG payments with TEFRA cost reimbursement to determine which has greater benefit and recommend transition strategies
  • Reimbursement impact analysis related to the merging of two hospitals for the purposes of the State of New Jersey subsidy fund reimbursement, all significant aspects of Medicare reimbursement and all significant aspects of Medicaid reimbursement
  • Financial impact analysis of obtaining Medicare PPS exempt status for inpatient psychiatric services, including the impact on the DSH rate, teaching reimbursement and wage index values
  • Expense benchmarking and reasonability analysis to support cost reduction efforts
  • Outsourcing of the reimbursement position

CBIZ can provide the services of an experienced reimbursement professional. Based on the needs of the client, CBIZ can provide the proper staff position to support your operations.

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Key Contact
Richard C. Parker Richard C. Parker Executive Director