Provider services and solutions

Financial performance: Reimbursement management

The challenge

Overlooked reimbursement opportunities. Miscalculating payments due from government programs. Caused by time constraints, incorrect data input and difficulties in collecting and managing large volumes of data. You can prevent or recover from these costly mistakes by carefully managing your reimbursement processes. Several government programs give providers opportunities to increase their government reimbursement. Not all providers take advantage of them. You should. Providers can obtain millions of dollars in additional revenue by correcting these miscalculations and oversights. For example:

• The Medicare Disproportionate Share Hospital (DSH) program provides add-on payments to hospitals that treat a high percentage of low-income patients. Low-income patients tend to be sicker and require more hospital resources. DSH payments compensate hospitals for the additional costs. Each additional day of Medicaid-eligible care can result in $250 to $500 in DSH funding. In a year’s time these additional payments can add hundreds of thousands to several million dollars to a hospital’s top-line revenue.
• The Medicare Wage Index (MWI) adjusts payments for geographical differences in labor costs. Staying abreast of changing MWI calculations can be difficult. Mistakes are costly. But getting it right can pay a hospital large dividends. As little as a one percentage change in wage index value could add millions in Medicare reimbursements to a large hospital.

How we can help you

• Hospitals can obtain significant revenue by correctly calculating add-on payments they are eligible to receive from the Medicare DSH program. We can analyze admissions, patient-day files, and other records to determine Medicare and Medicaid patient days for each facility and cost-report year. We can verify the data to justify Medicaid-eligible days. We can help you analyze and document Medicaid eligible days for DSH reimbursement. We have helped our clients calculate their Medicaid eligible days more accurately and efficiently, bringing them significant additional reimbursement revenue-up to several million dollars per cost report year.
• Errors and omissions in Medicare wage index data can result in significant Medicare payment reductions.
• We can improve the accuracy of your wage index data. PwC has experienced teams of professionals ready to assist either individual hospitals or groups of hospitals within a Core Based Statistical Area (CBSA) in the analysis of Medicare wage data. PwC can provide innovative and proven solutions that drive significant value to our wage index clients

Common services include

• Reviewing hospital patient information and documentation to identify opportunities to increase reimbursements
• Calculating and applying for Medicare DSH payments
• Calculating and applying for Medicare Wage Index adjustments