Disproportionate Share Reviews (DSH)

BESLER Helps to Simplify and Improve Your Abililty to Get Your Medicaid DSH Funding

BESLER’s Disproportionate Share (DSH) service optimizes a hospital’s Medicaid eligible days by capturing and validating every patient day eligible to be included in the Medicaid fraction of the Disproportionate Share calculation with the purpose of providing a clean and accurate log that identifies every possible account.

Why Choose BESLER?

  • BESLER leverages proprietary technology and experienced consultants who prepare, review, and work closely with your team to prepare a clean and accurate log of eligible Medicaid days on your cost report that is free of common errors, free of compliance issues, and preserves your appeal rights.
  • When BESLER prepares Medicare DSH, we process 100% of the patient population, validating Medicaid eligibility against the home state and against surrounding states when applicable.
  • A thorough analysis of ineligible patients will be conducted to ensure that each patients’ information was correct, confirming they are ineligible for Medicaid.
    • The remaining list of patients who have a high propensity for eligibility will be sent back to the state for a response.
  • We review issues and additional data provided to determine proper treatment and the decisions made based on a risk/reward analysis and review.
  • A second complete run of the data against the state’s database will be conducted one year later.
    • All states have retroactive eligibility, and CMS allows you to file an amended cost report, guaranteeing acceptance if DSH is the only change—allowing you to maximize your reimbursement on the amended cost report.
  • The BESLER team will answer all questions and provide additional supporting documentation during any subsequent audits aided by our expertise, experience, and understanding of typical audit-driven issues.

Not all DSH preparation services are equal. BESLER’s system makes getting your hospital its pro rata share of Medicare DSH funding easier

Contact BESLER and let our Reimbursement experts ensure that you are accurately calculating DSH and capturing every dollar of this shrinking pool.

Related Services

We provide consulting services in other related areas, including:

Audit Defensible Capture and Validation

BESLER’s uncompensated care healthcare reimbursement services capture and validate all eligible patient days for DSH, charity care charges for S-10 and bad debts that should be included on the Medicare Cost Report.

Click Data Below to Enlarge

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FY2024 IPPS Final Rule’s Impact to DSH

Effective 10/1/2023, the FY2024 IPPS Final Rule has reduced the UCC pool by $950M. The proposal only estimated a $115M decrease. The net percentage decrease is expected to be in the double figures for almost all categories and regions (see the table on page 2060 of the rule).

CMS finalized a proposal to clarify that the Medicaid fraction numerator in a hospital’s DPP includes patients covered by a Section 1115 waiver that provides either insurance covering inpatient care or fully subsidized premium assistance used to purchase such insurance. But for hospitals in a state with a Section 1115 demonstration that does not cover 100% of premium costs, patients in any such demonstration cannot be included in the numerator. That’s likely to affect the DPP of hospitals in a large majority of states. States in which Section 1115 subsidies do cover 100% of the premium cost to patients — meaning covered patients can be included in the numerator — include Arkansas, Connecticut, Massachusetts, Oklahoma, Rhode Island, Tennessee, Utah and Vermont. In addition, patients whose care is subsidized by uncompensated/undercompensated care pools established by a Section 1115 demonstration cannot be included in a hospital’s Medicaid fraction numerator. States affected are Florida, Kansas, Massachusetts, New Mexico, Tennessee and Texas.

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