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
Accurate cost reporting is critical to reimbursement, compliance, and financial planning for organizations participating in Medicare and Medicaid programs. LBMC helps providers prepare, review, and evaluate cost reports to identify reimbursement opportunities, address potential exposure, and prepare for audits. Learn more about the importance of accurate healthcare cost reports and their impact on reimbursement and financial performance.
- 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 with the compilation and review of traditional Medicare Bad Debts and Medicaid “crossover” Bad Debts, including helping organizations distinguish between contractual allowances and bad debt for accurate reimbursement and financial reporting.
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.
Healthcare Organizations We Support
LBMC provides reimbursement consulting for healthcare organizations operating across Medicare, Medicaid, and commercial payor environments. Our team understands that reimbursement requirements vary by provider type and helps organizations address the reporting, compliance, and financial issues that directly affect reimbursement.
Hospitals & Health Systems
LBMC works with acute care hospitals, behavioral health hospitals, long-term acute care hospitals, and health systems on cost reporting, reimbursement strategy, audits, bad debt, wage index considerations, and other issues that affect financial performance. We also help eligible hospitals evaluate reimbursement opportunities such as the Volume Decrease Adjustment (VDA) when changes in patient volume affect financial performance.
Rural Healthcare Providers
Critical Access Hospitals, Rural Health Clinics, Federally Qualified Health Centers, and other rural providers operate within distinct reimbursement and regulatory environments. LBMC helps these organizations navigate cost reporting, reimbursement requirements, and changes affecting rural healthcare delivery. Rural healthcare leaders can explore the reimbursement implications of Rural Emergency Hospitals (REHs) and learn how to establish audit readiness for the Rural Health Transformation Program as new funding is implemented.
Post-Acute & Long-Term Care Providers
LBMC supports skilled nursing facilities, nursing homes, home health organizations, hospice providers, and other post-acute organizations with reimbursement reporting, regulatory requirements, and financial issues specific to their payment environments.
Physician Practices & Medical Groups
LBMC helps physician practices and medical groups understand reimbursement performance, evaluate payor arrangements, and adapt to changing payment models. As healthcare continues to shift toward outcomes-based payment, organizations should understand the financial implications of value-based reimbursement and contracting.
Dialysis & Other Specialized Providers
LBMC provides reimbursement guidance for dialysis centers and other specialized healthcare organizations facing provider-specific reporting, payment, and regulatory requirements.
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?
Healthcare reimbursement consulting helps providers manage the financial and regulatory processes that determine how they are paid for services. Depending on the organization, this can include Medicare and Medicaid cost reporting, reimbursement analysis, audit support, bad debt reporting, payor contracting, pricing strategy, and identifying potential underpayments or reimbursement opportunities.
How can reimbursement consulting improve financial performance?
Reimbursement consultants can help identify missed reimbursement opportunities, reporting issues, underpayments, unfavorable contract terms, and operational factors contributing to revenue leakage. The objective is not simply to increase reimbursement, but to help organizations receive appropriate payment, reduce financial risk, and improve visibility into the factors affecting revenue.
Revenue cycle performance is also an important part of the broader financial picture. Learn how organizations can strengthen revenue cycle management in healthcare across the patient financial lifecycle.
What types of providers benefit from reimbursement consulting?
Organizations participating in Medicare, Medicaid, or commercial payor arrangements can benefit from reimbursement consulting, particularly when reimbursement rules or reporting requirements are complex. LBMC works with hospitals and health systems, Critical Access Hospitals, Rural Health Clinics, FQHCs, post-acute providers, physician organizations, dialysis providers, and other healthcare organizations with provider-specific reimbursement needs.
How does reimbursement consulting support compliance?
Reimbursement consulting helps healthcare organizations strengthen the accuracy and support behind cost reports, bad debt reporting, reimbursement filings, and other information submitted to government programs and payors. Consultants can also help organizations prepare for audits, respond to inquiries, identify potential exposure, and address reimbursement issues before they become larger financial or compliance problems.
What can healthcare organizations do to strengthen revenue cycle performance?
Healthcare organizations can strengthen revenue cycle performance by evaluating the processes that affect revenue from the beginning of the patient encounter through final payment. Areas such as charge capture, coding, claims management, denials, collections, payor performance, and operational accountability can all affect financial results. Explore these strategies for strengthening revenue cycle services to identify areas where performance may be improved.
When should a healthcare organization consider reimbursement consulting?
Organizations should consider reimbursement consulting when preparing cost reports or audits, experiencing unexpected reimbursement changes, negotiating payor arrangements, evaluating new services or acquisitions, or when financial results do not align with expectations. Support can also be valuable proactively, particularly when regulatory, operational, or organizational changes could affect future reimbursement.
How does LBMC approach reimbursement consulting engagements?
LBMC takes an ongoing, collaborative approach that connects reimbursement strategy with the operational and financial factors affecting each organization. Our team evaluates the current reimbursement environment, identifies risks and opportunities, supports implementation and reporting, and continues monitoring changes that could affect future reimbursement. This helps organizations move from reacting to reimbursement issues to managing them proactively.
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.