Reimbursement and Financial Support
In today’s healthcare environment, receiving the revenue to which you are entitled is critical to maintaining profitability. BESLER Consulting has long been at the forefront of national reimbursement issues, securing hundreds of millions of dollars in additional reimbursement through legislation and appeals. BESLER Consulting offers a reputation for quality and attention to detail, combined with a comprehensive team approach. Our areas of expertise include the following:
Medicare/Medicaid Appeals and Regulatory Analysis
Bad Debt Reviews/Maintenance Programs
BESLER Consulting has a proven track record with successful completion Medicare and Medicaid appeals for hundreds of client rate years. Many of these issues are found through our detailed cost report review process, but some are also discovered through our knowledge of the industry. BESLER has prepared subsequent re-openings and documentation to support our appeal issues and insure corrected payments. This process, which includes specific research and data comparison, can be completed by our seasoned professional staff. BESLER’s core group of highly qualified and innovative consultants can work with your reimbursement department to navigate this complex cost report review process.
Medicare Cost Report Reviews and Preparation
BESLER Consulting can assist in all phases of the cost report preparation and review. We'll give you tips on implementing policies and creating procedures for cost report data accumulation and preparation. BESLER Consulting also can assist in the re-opening and/or appeal processes as well. We will work closely with your staff to prepare supporting documentation for submission to your fiscal intermediary. For our clients, this process has resulted in increased revenue through corrected payments, which has helped them to meet their fiscal responsibilities and their social missions.
For years, the BESLER Consulting team has supported our provider clients in preparing initial bad debt logs as well as performing retrospective reviews of crossover, charity care and self pay bad debts. These debts are reinburseable on your instutitions Medicare Cost Report. Our process supports your team through the entire process from log submission through MAC Audit.
Medicare reimbursement regulations for Indirect Medical Education (IME) and Direct Graduate Medical Education (DGME) are increasingly complex and constantly changing, leaving hospitals to grapple with non-compliance issues that may result in reduced reimbursements. At BESLER Consulting, our commitment to clients is to ensure that we leave no Medicare cash uncollected while at the same time assuring compliance is maintained. Our IME/DGME Audit and Maintenance service will assist hospitals in their quest for compliance in this area and includes: review of policies and procedures for IME/DGME supporting documentation; periodic reviews of IME/DGME supporting documentation with written reports on any recommended changes.
Disproportionate Share and Medicad Eligibility Reviews (DSH)
BESLER Consulting provides the experience and expertise to review and prepare Disproportionate Share Hospital (DSH) analysis and submissions; ensuring that your DSH Analysis is complete, compliant and meets audit standards. Our team of consultants enjoys a reputation for quality, attention to detail, and exceeding clients’ expectations for revenue integrity.
Wage Index Opportunity and Analysis
The wage index schedules of the Medicare cost report have become increasingly more important over the last several years. The reporting on these forms should not only be reviewed in the effort to find “lost” Medicare reimbursement but also from a compliance standpoint. BESLER Consulting is a leader in the healthcare industry in wage index reviews and has assisted numerous hospitals in ensuring their wage indexes are accurate so they receive their fair share. We complete our wage index reviews and keeps the client informed of each and every adjustment.
855 Enrollment Process Assistance
BESLER Consulting will provide the expertise necessary to coordinate a facility’s efforts to gather all of the required information needed to complete the CMS-855. Professionals from BESLER Consulting will work with a facility to explain what is necessary and assist with any problematic areas in the information gathering process. BESLER Consulting has a strong background in regulatory matters and will assist a facility every step of the way, including submission and response to the appropriate federal agency regarding any questions with the submitted CMS-855.
Regulations in 42 CFR 413.65 describe the criteria and procedures for determining whether a facility or organization is provider-based. The Medicare Hospital Inpatient Prospective Payment System final rule published on August 1, 2002 (67 CFR 50078) revised those regulations that were to become effective on October 1, 2002, for facilities or organizations that were not grandfathered as provider-based and, in the case of grandfathered facilities, effective for main provider cost reporting periods beginning on or after July 1, 2003. Change Request 2411 provides information on the background of the provider-based regulations and notifies contractors of the actions that they are to take to implement the revised regulations.
Provider types impacted are those for which provider-based status affects the Medicare payment. For acute care providers, the most common examples are outpatient clinics. If considered provider-based, the clinic bills a facility charge under the hospital number to the intermediary and the physician's professional services to the carrier. If not considered provider-based, the clinic services would only be billed to the carrier. To be considered provider-based, the on-campus criteria must be met. For off-campus facilities additional requirements must be met.
At BESLER, we have assisted multiple providers navigate this process to determine whether its clinics are provider-based as well as tailor an implementation strategy to help optimize hospital resources, including the appropriate reimbursement. Working on behalf of your facility, we make every attempt to minimize your valuable time while maximize your return on investment.
Managed Care Modeling
Besler Consulting can model your managed care contracts in preparation of rate negotiations. This service will calculate the impact of the proposed rates compared to your current reimbursement. Besler can also assist you in modeling a change in reimbursement methodology for a managed care contract. For example the conversion of a managed care contract from fee schedule to APC rates or per diems to DRG rates.
Revenue and Expense Budget Preparation/Reviews/Analysis
BESLER Consulting has assisted providers in all phases of their budgeting process. Our staff can prepare or review both revenue and expense budgets and apply its knowledge of changes in the health care environment to tailor a specific budget for your facility. This would include but not be limited to changes in Federal and State payer reimbursement regulations. BESLER staff can also assist your management team in developing and application of assumptions that allow you to create a budgeting process that can be an ongoing dynamic tool to use throughout the year.
Strategic Financial Analysis
With over 20 years of experience in the industry, put our industry expertise to work for you. Whether you are considering an acquisition, divestiture, consolidation, psych unit decertification, combination of provider numbers, certification application or specific program analysis, our team is at the ready to serve as an extension of your staff or to lead the project from start to finish. We have successfully conducted multiple engagements
Interim Staffing and On-Demand Support Services
What Executive doesn’t need project help? Typically every Executive has, at any given time, a multitude of projects waiting implementation, but with management vacancies those projects rarely become a reality. BESLER Consulting will come in and fill the void in management to successfully implement corporate strategies and visions. Our industry professionals have the experience and dedication to become and active members in your revenue cycle. Whether your organization is trying to implement back burned projects or fill management vacancies, BESLER Consulting can assist your organization to build a more efficient revenue cycle.