Reimbursement Consulting

Reimbursement Consulting

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Helping nursing homes save money by proactively manage costs in a new reimbursement setting.

LBMC has been one of the most recognized firms in healthcare consulting for over a decade. Our dedicated healthcare industry team provides a wide range of services, including cost reporting and reimbursement consulting services for both cost-based and PPS providers. We understand the importance that cost reporting and reimbursement hold for healthcare entities, including nursing homes, and offer a wide variety of services to help you reach your goals.

Our unique partnership approach enables healthcare providers, including nursing homes, to anticipate potential changes in reimbursement rates by proactively monitoring operational changes throughout the year, eliminating rate setting surprises.

LBMC Healthcare Consulting provides a wide variety of services including:

Cost Reporting Services

  • Preparation or review of Medicare and/or Medicaid Cost Reports.
  • Review and assistance with tentative settlements, cost report audits, appeals and other correspondence with CMS and MACs.
  • Review previously filed cost reports in order to identify potential exposure and reimbursement opportunities.
  • Compilations or independent review of various Medicaid and other State Program Reports such as Residential Treatment Centers.

Payor Contracting and Negotiations

  • Review all current contracts for compliance, performance and renegotiate with payors, as appropriate, to obtain more favorable contract conditions and/or rates.
  • Review all new contract proposals and recommend acceptance or denial, based on potential performance and fit with the group’s strategy and goals.
  • Review payor market shares in your area and new contract recommendations.
  • Provide telephone and email support to your staff on questions related to payor contracts.
  • Provide ongoing monitoring of contracts for payor compliance.
  • Project environments: Hospitals (Ortho, Acute), ASCs, Rehab, Psych (inpatient and outpatient), Physicians (hospital and non-hospital based) and Ancillary services.

Consulting Services

  • Identify and assist with opportunities for Disproportionate Share (DSH) and Low Income (LIP) reimbursement for medical/surgical and rehabilitation hospitals, respectively.
  • Assist in compiling and/or review of traditional Medicare Bad Debts and Medicaid "crossover" Bad Debts.
  • Square Footage Analysis for proper cost allocations.

Other Reimbursement Services

  • Assist with Wage Index audits and review for potential Geographic reclassifications.
  • Consultations for various Provider based issues.
  • Assistance with completion and filing of occupational mix surveys.
  • Due dilligence to assist with opportunities and liabilities with acquisition/merger activities.

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Team

“LBMC has always been there when I needed them. They step in and relieve my resource gaps by providing a la carte expertise, while meeting my strict time constraints. Their work is thorough, and delivered with the professionalism we all deserve. Access to their team is a must-have asset for any organization in this challenging environment.”
Kevin Vaughn, AVP Operations Reimbursement and Revenue Integrity
RegionalCare Hospital Partners