In today’s healthcare environment, receiving the revenue to which you are entitled is critical to maintaining profitability. BESLER has long been at the forefront of national reimbursement issues, securing hundreds of millions of dollars in additional reimbursement through legislation and appeals. BESLER’s reimbursement services reflect our reputation for quality and attention to detail, combined with a comprehensive team approach.
Our areas of expertise include the following:
- Medicare Appeals and Regulatory Analysis
- Medicare Cost Report Reviews and Preparation
- Disproportionate Share and Medicaid Eligibility Reviews (DSH)
- Wage Index Opportunity and Analysis
- 855 Enrollment Process Assistance
- Provider-Based Determinations
Medicare Appeals and Regulatory Analysis
BESLER has a proven track record with successful completion Medicare and Medicaid appeals for hundreds of client rate years. These issues are found through our detailed cost report review process and through our extensive knowledge of the industry. BESLER has prepared subsequent re-openings and documentation to support our appeal issues and ensure 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 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 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 and ensure that you have preserved your appeal rights through protested items. 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.
Disproportionate Share and Medicaid Eligibility Reviews (DSH)
BESLER 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 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 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 will work with a facility to explain what is necessary and assist with any problematic areas in the information gathering process. BESLER 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.