Reimbursement Department Outsourcing
Are you having difficulty recruiting or retaining experienced individuals for your Reimbursement Department? Toyon Associates can help. As the nation’s largest firm solely focused on Medicare and Medicaid reimbursement we have the people who can staff your department while you look for the right employee. We provide everything from interim staff and department directors to simply outsourcing the routine functions.
Our goal is to help you prevent revenue loss and improve reimbursement during this time of transition. We will also analyze your system’s needs for regulatory support, rebuild or restructure your department, and provide continuity by assisting in the recruiting and training of your new staff.
Any amount of time without the proper reimbursement team can be costly. We’re here to help quickly mitigate any damages and to smooth that transition to an improved department that can demonstrate an effective compliance program.
Medicare Cost Report Preparation
The Medicare/Medicaid programs require annual cost report submission for hospitals. While only a fraction of hospitals receive cost-based reimbursement directly originating from the cost report, the report is vitally important. It is used to develop the Medicare wage index, DRG cost weights, and cost to charge ratios that drive your Medicare PPS payments.
Toyon uses the most advanced technology available in the industry to prepare your cost report right. Absolute, our state of the art software, standardizes the cost report process and ensures consistency and compliance.
Toyon Associates has a team of highly skilled experts dedicated to the production of Medicare/Medicaid cost reports. The benefits of having Toyon Associates compile your next cost report include:
Focus. In-house staff often need three months or longer to complete a cost report. Our robust software and experienced consultants require a fraction of that time. Let your staff focus on day-to-day operations and finding increased efficiency within your organization. While we concentrate on reporting and compliance, you can focus on maximizing the value of your staff’s time.
Innovation. As an industry leader in cost report preparation, we see more issues, discuss more strategies, develop more solutions, and have more experience. Put our breadth and depth of expertise to work for your facility to ensure you are not missing valuable opportunities.
Accuracy. Toyon Associates’ Absolute cost reporting software utilizes a multitude of safeguards to ensure precise and compliant reports. Absolute is continuously being enhanced and our consultants receive ongoing educational training. Our expert team creates accurate and reliable cost reports prepared to the highest and most current standards.
Peace of mind. When CFOs sign this document, they are personally certifying compliance. Sign with confidence! Toyon Associates delivers compliance, accuracy, and optimum reimbursement, year after year.
Medicare Cost Report Compliance
The Medicare cost report ranks as one of the government’s most complicated set of forms. It is no surprise that recent OIG audits have found that hospitals are systematically filing them incorrectly.
Inaccurate data has substantial repercussions. Not only do the Medicare cost reports affect Medicare payments, they are the basis of numerous financial analyses. Don’t let simple administrative errors compound into financial distress. It takes an expert to pursue maximum reimbursement while remaining in compliance.
Toyon Associates has developed a Cost Report Compliance Review Program to identify compliance issues. Our experts evaluate and disseminate ongoing changes in the federal regulations. We provide solutions specific to your facility that will allow you to demonstrate an effective compliance program.
Wage Index Optimization
The Medicare Wage Index impacts most Medicare payment systems among other third parties. It is crucial that your facility’s wage and benefit data is reported accurately and compliantly. Being “off” by just a small amount can cost you hundreds of thousands of dollars. Do not let inaccuracies devastate your financial operations.
Toyon Associates’ Wage Index Optimization services ensure that your hospital receives its maximum allowable share of the Medicare program’s entitlements. Our Wage Index Optimization services include the following strategies:
Scrutinize. We thoroughly analyze the hospital’s filed wage, benefit, contract labor and home office data for accurate wage index reporting.
Interpret. Our experts have spent decades working with and understanding federal regulations. We have extensive experience understanding and interpreting complex wage index instructions to optimize wage data filings.
Recommend and Support. Our strategic corrections ensure accurate and optimal data. Toyon’s recommended findings are supported throughout the wage index timetable with auditable work-papers and constant communication with your hospital staff.
Toyon also offers the following wage index services:
- Geographic reclassification analysis and application filing services
- Medicare Occupational Mix Survey preparation and review services
- Urban-to-rural re-designation optimization
Medicare Disproportionate Share Hospitals
Medicare Disproportionate Share Hospital (DSH) entitlements are one of Medicare’s most scrutinized areas. This add-on payment for hospitals serving low-income patients can be significant, but the DSH days must be reported in a compliant manner. Toyon Associates has decades of experience preparing DSH listings and working closely with the Medicare Intermediaries to document and support the Medicaid eligible day population.
We have the expertise and knowledge to maximize your hospital’s claimable Medicaid eligible days. During the audit, we will work closely with your staff to ensure that sufficient patient documentation is provided to support the Medicaid eligible days. Our team is well-versed in properly documenting the eligible days to satisfy the audit requirements.
Toyon Associates can assist with all phases of the DSH preparation including the appeal process. Please click here for more information regarding appeals.
Uncompensated Care Recognition Services
Changes in healthcare policy have an increased emphasis on hospital performance and community benefit. Toyon’s Uncompensated Care Recognition Services (UCRS) are tailored to correlate the charitable work your hospital provides to your community with the right data to support it.
CMS’ new instructions for reporting uncompensated care are complex and drive billions of dollars in hospital payments. Toyon ensures your data is correct data while verifying it is aligned. We compliantly report uncompensated care cost on worksheet S-10 of the Medicare cost report by thoroughly reviewing claims related to charity care, self-pay accounts, non-covered Medicaid eligible services, and bad debt. We work with over 100 clients who depend on the accuracy of their data. Toyon’s dedication to our clients means the numbers are right.
We don’t stop at the numbers. We work closely with our clients, recommending changes to both hospital policy language and transaction codes to capture all allowable uncompensated care cost today and in the future. Toyon correlates this information with your hospital’s charitable contribution as recorded on other state and federal reports to help tell the right story about the charitable work your hospital provides to its community.
We are here to help. Toyon is actively engaged in providing our clients with Uncompensated Care Recognition Services, while at the same time analyzing and projecting uncompensated care data with our team of reimbursement experts and other industry leaders. Our team is prepared to share our knowledge with you and will follow up with a complimentary uncompensated care analysis for your hospital.
Medicare Bad Debts
How many hundreds of thousands of dollars are you losing due to Medicare bad debts? With Medicare Intermediaries constantly developing more stringent requirements for claiming Medicare bad debts, it is becoming more difficult to claim lost revenue. Today’s complex regulations require you to provide increasingly comprehensive and credible documentation, as well as demonstrating reasonable collection efforts.
Hospitals face a conundrum. You cannot afford the consequences of ignoring these stringent requirements. At the same time, you have a hospital to run – you cannot afford to spend all your time deciphering ever-changing regulations.
Toyon Associates provides expert guidance in recouping Medicare bad debts. Our experts have spent decades working with the Medicare Intermediaries, meeting the evolving procedural requirements needed for capturing all allowable reimbursement, while maintaining compliance.
In addition to compiling and merging Medicare and Medicaid claim information, our robust software identifies accounts that the Intermediaries will not allow, but should be pursued in appeals.
Medicare / Medicaid Appeals
Federal and state legislation has become even lengthier and more complex, while the window for action has become increasingly narrow.
Both the Medicare Provider Reimbursement Review Board (PRRB) and Medicaid agencies have strict procedures for filing and pursuing appeals.
Failure to understand and apply these procedures can cost your facility hundreds of thousands to millions of dollars. You have a hospital to run. Do you have the time and resources to become an expert in healthcare principles and regulations?
At Toyon Associates, we are among the largest and most successful appeals practices in the country, devoted to analyzing the complex federal regulations that impact Medicare and Medicaid. Our experts protect your appeal rights. We reach an administrative resolution 95% of the time.
Our appeals practice will:
- Assess your audited cost reports
- Identify viable appeals and issues
- Pursue appeals
- Address jurisdictional challenges
- File position papers
- Represent your facility
- Obtain settlements
Medicare IME / GME Services
Teaching hospitals rely heavily on Medicare Indirect and Direct Graduate Medical Education (IME/GME) reimbursement.
The IME/GME payment provisions are among the most sophisticated in Medicare reimbursement. If you’re not an expert in this complicated environment, you may be losing out on significant reimbursement to which you may be entitled.
These complex regulations have a number of critical components that may have different requirements depending on the applicable cost reporting years.
Specific areas of focus include:
- New GME program planning (reimbursement issues, budgeting, etc.)
- Counting/auditing of resident FTEs and related documentation requirements
- Assessing residents working in non-hospital settings
- Tabulating time spent in administrative or didactic activities
- Determining time spent in various types of research activities
- Counting resident time in psych and rehab units
- Reviewing Medicare affiliated group agreements
- Navigating cost report complexities (weighting/averaging of residents, caps, etc.)
- Program budgeting and planning
- Counting of available beds
- Educating faculty and stakeholders
The consultants at Toyon Associates have decades of experience assisting teaching hospitals with IME/GME reimbursement issues. We work with academic medical centers and teaching hospitals on virtually every aspect of Medicare indirect and direct GME.
Financial Feasibility Analysis
Is your hospital considering adding or changing services? Concerned about the Medicare/Medicaid impact of the service changes? Toyon Associates’ team of highly skilled specialists has decades of experience in financial feasibility analysis. We can assist you in forecasting the results.
Medicare’s reimbursement systems are complex. Our consultants analyze your options and quantify how today’s decisions will affect tomorrow’s Medicare reimbursements.
- Determine the impact of consolidating two hospitals.
- Add, change or eliminate services
- Analyze the impact of changes in regulations.
- Assist in the planning for expected reimbursement at new hospitals.
Organ Acquisition Reimbursement
Are you confident that you are capturing accurate Medicare reimbursement for your organ transplant center? The OIG has reported that more than half of the dollars claimed for organ acquisition costs are inaccurate.
Toyon Associates has the experience and expertise to assist certified transplant centers in complying with stringent Medicare requirements for claiming organ acquisition costs. In addition, Toyon can review your hospital’s internal processes related to claiming organ acquisition costs including:
- Documenting proper organ acquisition costs
- Allocating shared and other overhead costs
- Billing Medicare and non-Medicare payers for pre-transplant services related to prospective recipients and live donors
- Medicare and total usable organ counts
- Standardizing Acquisition Charges
End Stage Renal Disease Reimbursement
Medicare provides an add-on payment for facilities that experience a high percentage of End Stage Renal Disease (ESRD) discharges. Facilities that experience eligible inpatient discharges where dialysis is provided that meets or exceeds the ten percent threshold are eligible for a per discharge payment. This payment is based on historical cost as determined by Medicare.
The add-on payment is meant to reimburse facilities for providing dialysis for patients that are admitted for diagnoses unrelated to their renal treatment.
At Toyon Associates, we have an experienced research and analytics practice that provides exceptional reimbursement advisory services for providers participating in the Medicare and Medicaid programs. Toyon has an ESRD research protocol that is jointly approved by the National Institutes of Health (NIH) and CMS. This protocol provides the ability for facilities to analytically evaluate their eligibility for this add-on payment and minimize audit risk.
Our ESRD research team will:
- Analyze your facility’s eligibility for the ESRD add-on payment.
- Submit all necessary documentation to the MAC.
- Provide audit support during MAC review.
OSHPD Annual Report Preparation
The State of California requires all acute and long-term care hospitals to file quarterly and annual hospital disclosure reports. It is crucial that these detailed reports are accurate. Not only is all the information within these reports publicly available, but the impacts derived from the data may directly affect your Medi-Cal disproportionate share reimbursement.
Prepared in-house, an OSHPD disclosure report diverts hundreds of hours from daily operations. Is preparing an annual OSHPD report the best use of your staff’s time?
Toyon Associates has developed a sophisticated software program that automates many parts of the report generation and ensures an accurate annual report.
Additional Medi-Cal funds are available to California hospitals that provide care to a significant number of low income patients. Is your facility receiving its fair share of Medi-Cal DSH reimbursement?