Other Services

OSHPD Annual Report Preparation

The State of California requires all acute care hospitals to file an annual hospital disclosure report. It’s crucial that this detailed report be accurate. Not only does the world get to see your numbers, but the data can have a direct impact on 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 sophisticated software programs that automate many parts of the report generation and ensures an accurate annual report.

Interested in increased efficiency, heightened accuracy, and lower costs? Contact us today.

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's becoming more difficult to claim lost revenue. Today's complex regulations require healthcare facilities to provide increasingly comprehensive and credible documentation, as well as demonstrating reasonable collection efforts.

Hospitals face a conundrum. You can’t afford the consequences of ignoring these stringent requirements. At the same time, you have a hospital to run – you can't 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 maximum reimbursement.

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.

Ready to recoup more of your Medicare bad debts? Contact us today.

Medicare Cost Report Compliance

The Medicare cost report ranks as one of the government's most complicated set of forms. It's 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 analysis. 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 hospital.

Compliance brings peace of mind. Contact us today.

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 have 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 impact tomorrow's Medicare reimbursements.

Samples of recent financial feasibility analysis include:

Determining the impact of consolidating two hospitals. We analyzed the future Medicare DSH allowable percentage and the Inpatient Medicare Acute cost to charge ratio which directly affect Medicare outlier payments.

Analyzing the impact of adjusting the Interns and Resident program. Depending upon the set-up and documentation, the change in reimbursement can be millions of dollars per year.

Discovering opportunities within new regulations. Each year Medicare updates rates and submits new rules. As we review the impact, we assess whether it's viable to make a request for change. Most recently, we submitted a Medicare wage index reclassification request. Two hospitals increased their reimbursement by $1.5 million per year.

Peer Grouping Inpatient Reimbursement Limitation (PIRL)

Did the Hospital Recoupment Unit (HRU) declare that your facility has to return thousands of dollars? Unlike cost reports, PIRL has no statute of limitations. Years after your reports have been filed, an HRU audit can determine your facility exceeded the PIRL limitation.

Toyon Associates can assist with obtaining relief to the PIRL limitations. Our consultants have a high success rate in obtaining full relief or substantially reducing the liability. Our healthcare consultants will:

Verify HRU's calculations. We review HRU's data for your facility and ensure it's reasonably stated and free from errors.

File AAR. Our specialists file the administrative adjustment request on your behalf.

Document. We support each basis of relief with the necessary documentation.

Settle. We are highly successful in reaching an agreement before the formal hearing stage.

Ready to recoup your losses? Contact us today.

Medi-Cal Disproportionate Share

In California, additional Medi-Cal funds are available to Hospitals that provide care to a significant number of low income patients. Is your facility receiving its fair share of Medi-Cal DSH reimbursement?

Almost every hospital which receives Medi-Cal DSH qualifies under the low income percentage threshold, as calculated from the annual OSHPD report.

Ensuring proper reporting of the Medi-Cal net reimbursements is imperative for qualifying and maximizing the entitlements available to the hospital. Toyon Associates has developed a review process to ensure the proper and accurate reporting of Medi-Cal net revenues for the Medi-Cal DSH purposes.