Reimbursement Services for Prospective Payment System Clients
Times are tight. You can’t afford lost revenue.
If you’re not sure you are receiving all appropriate payment…
Here’s how QHR can help.
The knowledge to find your reimbursement potential and the tools to get it.
Changes in your hospital or service area may qualify your organization for a multitude of reimbursement opportunities. And the frequent regulatory changes shaping and reshaping our industry make it difficult to know if you’re properly reimbursed for the care you deliver.
QHR has guided hospitals through Prospective Payment System (PPS) reimbursement since the system was introduced to hospitals, more than 20 years ago. We know how to assist you in receiving the appropriate reimbursement from Medicare and Medicaid payers.
Contractual Accounting Review
QHR specialists review your contractual accounting processes, allowances and cost report settlements as reported on your financial statements. This review assists hospital executives in presenting accurate financial statements to the Board. We can develop contractual accounting models for use in your hospital’s financial reporting process.
End Stage Renal Dialysis (Exception Payment Request)
We determine whether your hospital can qualify for ESRD payment adjustment; if so, we can assist the hospital in filing for payment adjustment with CMS.
Reimbursement Advisory & Legislative Update
This email resource explains legislative and regulatory changes in reimbursement in terms you can understand, and indicates the impact of these changes on hospitals.
Reimbursement & Cost Report Studies
QHR experts review your cost report for accuracy and compliance with current regulations. We also identify missed reimbursement opportunities.
- Disproportionate Share Hospital (DSH) Reimbursement Study: We examine claimed DSH reimbursements on current and settled cost reports, and develop methods to track “Paid Medicaid Days” and other days included in DSH formula.
- Medicare Bad Debts Review: QHR experts identify Medicare bad debts that may have not been claimed on your hospital’s annual Medicare cost report by reviewing your claimed bad debt and internal PFS functions.
- Medicare Dependent Hospital Designation: Our specialists determine whether your hospital qualifies as a Medicare Dependent Hospital; if so, we provide application assistance and reimbursement benefit.
- Sole Community Hospital Designation: QHR staff evaluates your hospital’s qualification as a Sole Community Hospital. If the hospital qualifies, we can assist in the application process.
- State Disproportionate Share Hospital (DSH) Payment Application and Payment Review: We review data submitted to your state for DSH reimbursement for accuracy, completeness, and compliance with state regulations.
- Medicare Geographic Reclassification and Wage Index Review ensures that your hospital’s wage portion of the prospective payment is accurate. Our reimbursement consultants can review the various scenarios available to the hospital for geographic reclassification and assist in the request for reclassification.
