Reimbursement Consulting
LBMC has been a recognized firm in healthcare consulting for more than 20 years. Our dedicated team provides a wide range of services, including cost report preparation and review, and reimbursement consulting services for both cost-based and PPS providers. We provide payor negotiations, contracting services, chargemaster reviews and strategic pricing adjustments to meet today’s need for more transparency in healthcare pricing.
Our unique partnership approach enables healthcare providers to anticipate potential changes in reimbursement rates by proactively monitoring operational changes throughout the year, eliminating rate setting surprises. At LBMC, we understand the importance that cost reporting and reimbursement hold for healthcare entities and offer a wide variety of services to help you reach your goals.
How Reimbursement Consulting Works in Practice
Reimbursement consulting is not a one-time project—it’s an ongoing process that connects financial performance, regulatory requirements, and operational decisions.
At LBMC, engagements are structured to provide clarity and consistency throughout the year, helping providers avoid surprises and make informed decisions as conditions change.
- Discovery and current state review: We evaluate your reimbursement model, cost reports, contracts, and operational drivers.
- Reimbursement and compliance assessment: Our team identifies risks, missed opportunities, and areas of exposure across Medicare, Medicaid, and commercial payors.
- Strategy and planning: We develop a clear plan to improve reimbursement outcomes, support compliance, and align with your organization’s goals.
- Execution support: We assist with cost reports, audits, negotiations, and filings, working alongside your internal teams.
- Ongoing monitoring and advisory: As regulations and operations evolve, we provide continuous guidance to help you stay ahead of changes.
Why Healthcare Organizations Seek Reimbursement Consulting
Reimbursement challenges are rarely isolated; they impact financial performance, compliance, and long-term strategy. Many organizations turn to reimbursement consulting when internal resources are stretched or when reimbursement outcomes become unpredictable.
Common reasons providers seek support include:
- Increasing complexity in Medicare and Medicaid reimbursement rules
- Declining or inconsistent reimbursement rates
- Cost report audits, appeals, or settlement disputes
- Limited visibility into reimbursement drivers and financial impact
- Payor contract negotiations and pricing strategy challenges
- Organizational changes such as acquisitions, expansions, or service line growth
- Risk of underpayments, overpayments, or compliance exposure
- Lack of internal resources to manage reimbursement proactively
Reimbursement consulting helps healthcare organizations improve accuracy, reduce risk, and create a more predictable financial outlook.
Questions About Reimbursement Services?
If you’re managing cost reports, navigating reimbursement changes, or preparing for audits, our team can help you identify opportunities, reduce risk, and plan your next steps with confidence.
Reimbursement Consulting Services
Cost Reporting Services
- Preparation and/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 of 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.
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 diligence to assist with opportunities and liabilities with acquisition/merger activities.
Types of Clients Served
- Acute care hospitals (ACH)
- Behavioral health hospitals (BHH)
- Critical access hospitals (CAH)
- Dialysis centers
- Federally qualified health centers (FQHCs)
- Home health care
- Home offices
- Hospice facilities
- Long-term acute care hospitals (LTACH)
- Nursing homes
- Physician practices
- Rural health clinics (RHCs)
- Skilled nursing facilities (SNFs)
Local Expertise, Wherever You Are
With offices in Chattanooga, Memphis, Louisville, Nashville, Knoxville, Philadelphia, and Charlotte, plus remote offices, LBMC partners with businesses across the region and beyond.
FAQs About Reimbursement Consulting Services
What is reimbursement consulting in healthcare?
Reimbursement consulting focuses on helping healthcare providers optimize how they are paid by Medicare, Medicaid, and commercial payors. This includes cost reporting, compliance, contract strategy, and identifying opportunities to improve reimbursement outcomes.
How can reimbursement consulting improve financial performance?
By identifying underpayments, correcting cost report issues, and improving contract terms, reimbursement consulting helps providers capture appropriate revenue and reduce financial leakage.
What types of providers benefit from reimbursement consulting?
Hospitals, physician groups, post-acute providers, and other healthcare organizations that rely on government or commercial reimbursement models can benefit, especially those experiencing growth, audits, or regulatory changes.
How does reimbursement consulting support compliance?
Reimbursement consultants help ensure cost reports, bad debt reporting, and other filings align with CMS and state requirements, reducing audit risk and supporting accurate reporting.
When should a healthcare organization consider reimbursement consulting?
Organizations often seek support during audits, after reimbursement changes, during mergers or acquisitions, or when financial results do not align with expectations.
How does LBMC support reimbursement consulting engagements?
LBMC combines cost reporting, reimbursement strategy, and operational insight to provide ongoing guidance, not just project-based support — helping organizations stay ahead of changes and avoid surprises.
LBMC Executive Team
Let’s Talk About Your Healthcare Organization
Whether you’re navigating regulatory challenges, improving financial performance, or planning for growth, LBMC’s healthcare team is ready to help. We’ll start with a conversation focused on your organization’s goals, current priorities, and where you need support.