Complete

turning transactional reimbursement into strategic value


We believe today’s transformative environment demands that providers reimagine their traditional reimbursement functions. No longer a tactical process, the reimbursement function has emerged as a strategic advantage for forward-looking organizations of all sizes. But to unlock that strategic advantage, leaders must develop lasting processes and strategies to meet not only regulatory compliance requirements but also play critical roles within the organization's overall strategy and change management.

Our Complete solution set is designed to come alongside organizations of any scale with both expertise to navigate complex technical issues and the capacity to meet regulatory and compliance challenges of any size. This combination is unique to DHG Healthcare and makes us the guide your organization can trust. Listed below are just a few of the offerings we provide our clients to support their journey.

Offerings

 

Offering Listing

  • Complete

Foundation Offerings

  • Cost Reporting & General Compliance
  • DSH & Uncompensated Care Reporting

Strategic Products

  • Medicare Bad Debt
  • Medicare Wage Index
  • Medical Residency
  • Provider-Based Solutions
  • RHC Consulting
  • Organ Acquisition Advisory
Foundation Offerings

Medicare / Medicaid Cost Reporting

Our approach to serving our clients is to guide each hospital and health system as an extension of your reimbursement department as we prepare the cost report. This is accomplished by not only ensuring that all compliance requirements are met on a timely basis, but also working with your hospitals and health systems in identifying and addressing critical reimbursement issues and opportunities.

Disproportionate Share Hospital (DSH) Solutions

DHG Healthcare is the industry leader in Medicare Disproportionate Share Hospital (DSH) reimbursement services. We utilize high powered data analytic platforms and a proprietary process to optimize DSH reimbursement for our hospital clients. With over 30 years of DSH reimbursement experience, DHG Healthcare has developed direct working relationships with key stakeholders at the State Medicaid Agency level which enables us to capture and document all Medicaid eligible days. Our services yield improved results by discovering eligible days that are often overlooked by an abbreviated approach while also maintaining compliance with all applicable regulatory standards.

In addition, our DSH Solutions also include assisting in the preparation of Medicaid DSH Surveys in multiple states. This preparation can vary in scope from a compliance approach to a very detailed analysis that includes all inpatient and outpatient discharges. The detailed analysis includes assessment of the various populations included in the Survey as well as research to identify additional uninsured charges and additional Medicaid eligible accounts. The detailed analysis is utilized by several of our clients in states that use the DSH Survey to determine how Medicaid DSH payments are allocated.

Strategic Products

Medicare Bad Debt

DHG Healthcare has a devoted Medicare bad debt team comprised of a core group of professionals responsible for preparing Medicare bad debt logs, monitoring key regulatory developments in this area, and provide Medicare audit assistance for routine audits as well as cost report appeals and reopenings. This level of specialization allows our team to focus on providing the highest level of service to engaged clients. The clients range from small independent hospitals to national healthcare corporations.

DHG Healthcare assist providers in accumulating and preparing Medicare bad debt listings in a format ready to be submitted to Medicare in coordination with the current year Medicare cost report submission, or as part of an amendment or reopening of prior year Medicare cost reports. We utilize next generation data analytic platforms and a proprietary process to complete the logs to ensure compliance as well as optimize reimbursement. Our process utilizes data from multiple sources to maximize the Medicare bad debt accounts identified for reimbursement.

Medicare Wage Index

DHG Healthcare has a devoted Wage Index team comprised of a core group of professionals responsible for monitoring key wage index developments and leading our assessment engagements. This level of specialization allows our team to focus and to provide the highest level of service to engaged clients. Our Wage Index team’s combined experience has been with nearly 170+ cities and includes providing services to the largest CBSAs in the country, entire state rural CBSAs, as well as individual hospitals. Those engagements include working with all size hospitals and health systems in coordination with the full complement of all CMS Medicare contractors.

Our approach in these type engagements is extensive, focused on obtaining a detailed and complete understanding of the provider’s current and historical organizational and operating structure, as well as the provider’s systems. Our acquired familiarity in these areas enables a more insightful assessment into the underlying wage data and provides an ability to determine meaningful and value-added corrections for an improved determination of the provider’s average hourly wage, and subsequently the area’s Medicare wage index. We assist our clients throughout the full continuum of the wage index process from as-filed assessments to assisting with the Medicare Wage Index audit and appeals.

We strive to work with you to develop an efficient process to accumulate the necessary information, analyze it and accurately reflect it in the cost report. We believe we can provide additional value by identifying potential issues within the information we are provided and can offer suggestions for possible improvements either in the current cost report or in future years.

In order to provide this level of service, we have assembled a team of professionals whose entire focus is on preparing and reviewing cost reports and providing related reimbursement services. This level of specialization has provided us with an extensive base of knowledge and experience to call upon. Some firms may regard preparing the cost report as an afterthought overshadowed by their desire to pursue special projects. Other firms treat cost reports as a commodity, providing little more than data entry with minimal thought beyond the numbers they are provided.

We believe the cost report is an important output for every hospital, for both meeting regulatory and compliance requirements and for optimizing reimbursement. Preparing cost reports is the foundation for the entire range of reimbursement services we provide.

Medical Residency

We assist hospitals with feasibility analyses, education, and implementation of medical residency programs. We utilize a phased approach that begins with a facilitated on-site education and design session for all relevant key stakeholders within the organization that results in a preliminary roadmap for implementation. This phase is then followed by the creation of a financial analysis and related business considerations models with projected Medicare and Medicaid reimbursement. It also includes estimated expenses based upon assumptions developed in coordination with our client in combination with industry perspective. Based upon these two phases, the organization will then decide whether or not to proceed with implementation.

The final phase of our solution set is to work with your organization as an advisor/project manager throughout the implementation phase by working with leadership in the hospital, along with medical residency leadership as well as applicable third-party stakeholders such as the ACGME and CMS. For each engagement, DHG Healthcare custom tailors the approach based upon the needs and resources that are requested by our clients.

Provider-Based Solutions

DHG Healthcare assist providers in understanding the complex regulatory, reimbursement, and operational considerations related to provider-based status for physician practices, hospital outpatient departments, and rural health clinics.  Our involvement includes financial assessments, regulatory gap analysis, transition advisory services, assistance with design and structure, as well as revenue optimization.  Our highly specialized team also provides accreditation awareness and identifies compliance risks associated with provider-based status.

Provider Designation Solutions

DHG Healthcare serves organizations throughout the country by utilizing our deep technical expertise along with our sophisticated, accurate and extensive CMS data modeling capabilities to assist hospitals in the area of Medicare special designations and geographic reclassifications. DHG Healthcare’s Provider Designation Group is a specialized team specifically devoted to the development and identification of opportunities for our clients. This team continuously monitors regulatory changes and works closely with legal consultants to monitor the ever-changing legal and regulatory landscape in this area. Utilizing this approach, we creatively identify, design, and facilitate implementation of unique scenarios that often result in significant Medicare revenue enhancement for our clients. The offerings included in this solution set include the following: Medicare geographic reclassification and designations (i.e. Section 401), Medicare special designations (i.e. SCH, MDH, RRC, CAH), and provider consolidation and merger assessments.

Organ Acquisition Advisory

We will assess all aspects of the hospital’s kidney, liver and lung transplant programs that affect cost reporting and proper Medicare reimbursement.  Specific components we will examine include direct costs, overhead allocations, organ acquisition costs, counting of organs, Medicare Secondary Payer (MSP) organs, split of pre-transplant versus post-transplant services, cost report reclassifications and adjustments, and time studies.

Experience

 

DHG Healthcare Complete solution set is delivered by over 50 professionals focused solely on Medicare and Medicaid regulatory and compliance advisory services. This scale and expertise are the reason we have established long-standing relationships with respected hospitals and health systems throughout the country. We augment this core group with specialists in areas across the reimbursement spectrum. Functioning as a single centralized team, our deep expertise and purposeful engagement management approach powers an impactful engagement experience marked by consistency, collaboration and accountability.

We believe today’s transformative environment demands that providers reimagine their traditional reimbursement functions. No longer a tactical process, the reimbursement function has emerged as a strategic advantage for forward-looking organizations of all sizes. But to unlock that strategic advantage, leaders must develop lasting processes and strategies to meet not only regulatory compliance requirements but also play critical roles within the organization's overall strategy and change management.

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