Medicare & Medicaid Reimbursement Services

It has become increasingly more difficult to find experienced, strategic-minded reimbursement leadership with the knowledge needed to ensure the accuracy of your report filings as well as assist management with strategic planning and implementation.

Baker Tilly provides assistance to hospitals and health systems with regulatory impact changes and analysis, third-party accounting assistance, analysis of operational changes and the impacts on reimbursement as well as education of hospital staff and leadership. In addition, Baker Tilly has the resources to assist with additional assistance when temporary resources are needed.

In addition to helping organizations prepare and review their Medicare and Medicaid cost reports (MCRs), our team of specialists can also assist with Medicare audits, amending and reopening previously submitted MCRs. Baker Tilly works with Medicare Audit Contractors (MAC) throughout the U.S. and can assist clients with protested amounts and appeals of issues related to each hospital’s specific needs.

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 prepare your Medicare bad debt logs from hospital data, review logs prepared by the hospitals, verify and identify Medicare bad debt claims, standardize procedures to ensure accurate record keeping and tracking of bad debts throughout the year, and assist with potential Medicare bad debt audits.

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 eligible 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.

In addition, our team can review your charity care policy for compliance with IRS regulation 501(r) and ensure that actual charity adjustments follow your charity care policy.

Labor costs are a major hospital 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.

The Occupational Mix Survey (OMS) is completed on a calendar year basis – once every three years – which measures the intensity of nursing hours providing direct patient care compared to other hospitals throughout the country. The OMS results are used to adjust the wage index up or down based on their hospital’s occupational mix or their metropolitan statistical area, compared to all others.

At Baker Tilly, we provide OMS preparation as well as review services to comply with this CMS regulation. We also help with providing wage index comparisons of the current year wage index to the proposed wage index and your potential options for improvement.

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. In addition, the last few years have brought significant regulation changes impacting graduate medical education, and some of these changes have had an adverse impact on nursing and allied health program payments.

At Baker Tilly, we can assist you with strategies regarding your resident cap, shadow billing, the impact of bed changes on your IME reimbursements, verify your resident fellows are properly recorded and reimbursed, and make sure your organization is up-to-date on all medical education regulations.

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.