Hospital Reimbursement

Be prepared for emerging legislation and understand how payer contract provisions may impact reimbursement.

CLA advises health care organizations on how changes in the regulatory and business environments impact reimbursement.

What’s on your mind?

  • How your state’s unique rules and regulations impact reimbursement, including supplemental payments
  • How new laws and regulations specifically affect your Medicare and Medicaid reimbursement (i.e., PPS, critical access, safety net, etc.)
  • Receiving full reimbursement
  • How organizational and/or marketplace changes impact reimbursement
  • How to work with payers on new ways of paying for services without reducing reimbursement
  • Receiving completed cost reports — on time — and in a meaningful format

A unique approach

Our interactive engagement process will involve your personnel from start to finish. We work alongside you to gain a deep understanding of the issues unique to your organization. This helps us tailor our reimbursement services to your organization’s structure and challenges.

Many of our reimbursement professionals have firsthand experience working in a variety of health care organizations. Our reimbursement team keeps abreast of the Medicare and Medicaid rules and regulations on a federal and state level. We proactively advise you on how to reach peak operating performance, while attending to risk.

On an annual basis, we prepare or review nearly 600 Medicare and Medicaid cost reports. We deliver our services with uncompromising integrity and the highest level of quality.

Reimbursement services for hospitals

  • Medicare and Medicaid cost report preparation, analysis, and audit assistance
  • Strategic reimbursement planning: government and health plan
  • Cost report diagnostic reports
  • Revenue cycle performance management
  • Intermediary/MAC and Provider Reimbursement Review Board appeals
  • Medical education reimbursement compliance and analysis
  • Medicaid supplemental payment analysis and optimization
  • Negotiate with payers for increased reimbursement carve outs
  • Third-party payer contract review
  • Wage index, occupational mix adjustment, Medicare bad debt, and organ acquisition analysis
  • Medicare and Medicaid Disproportionate Share Hospital reporting