Medicare & Medicaid Reimbursement Strategies

In addition to helping organizations prepare and review their Medicare and Medicaid cost reports (MCRs), our team of specialists can also assist with auditing, amending and reopening previously submitted MCRs.

If a Medicare beneficiary is unable to pay for their care and the provider has made a reasonable effort to collect the claim, Medicare will reimburse the provider the unpaid deductible and/or coinsurance (i.e., Medicare bad debt). Baker Tilly’s Medicare bad debt services can help providers verify and identify Medicare bad debt claims, as well as standardize procedures to ensure accurate record keeping and tracking of bad debts throughout the year.

Per federal regulations, providers that administer a high percentage of their services to low-income patients can take advantage of Medicare Disproportionate Share Hospital (DSH) adjustments. At Baker Tilly, we can help determine if your organization is eligible for DSH, including verifying Medicaid paid and eligibility days, supplemental security income (SSI) realignment and more. We can also help your hospital achieve a higher level of DSH payment for 340B qualification.

To fully capture reimbursements, hospitals must correctly file their Worksheet S-10 to determine their annual amount of uncompensated care. At Baker Tilly, our team will review or prepare your S-10 account logs, identify and remove any non-allowable charges, reconcile data and help identify sums that may otherwise fall through the cracks.

Labor costs are a major expense and filing Medicare’s WI information helps ensure consistent payment structure across all campuses while recognizing that the cost of labor varies in different markets. Baker Tilly can help hospitals with reviewing their annual WI as well as confirming that wages, benefits and contract labor are correctly identified and recorded. In addition, we can identify trends and potential opportunities as well as provide support to the Medicare Audit Contractor (MAC) if they have any questions during their review.

Hospitals are subject to reduced payments under a transfer DRG if a patient is discharged and receives specific types of post-acute care. Baker Tilly can help hospitals examine their claims data to determine whether the post-acute care ultimately received by patients qualifies for the transfer DRG and help identify DRG underpayments on behalf of the hospital.

For teaching hospitals, reimbursements for graduate medical education (GME) and indirect medical education (IME) can be significant. At Baker Tilly, we can assist you with strategies regarding your resident cap, shadow billing, the impact of bed changes on your IME reimbursements and make sure your resident fellows are properly recorded and reimbursed.

In order to help reduce the financial burden of caring for patients, CMS has designated special statuses for certain hospitals and clinics, including:

• Critical Access Hospital
• Sole Community Hospital
• Low Volume Designation
• Medicare Dependent Hospital
• Rural Referral Center
• Provider-Based Clinics
• Rural Health Clinics

At Baker Tilly, we can help assess whether a hospital or their clinics may be eligible for one of these specialized designations and what the potential reimbursement impact may be. Once identified, our Baker Tilly enrollment, compliance and reimbursement specialists can assist hospitals to get enrolled and established with CMS accordingly.