Medicare Cost Report Appeals & Reopenings

Medicare Cost Report Appeals

Proper Medicare reimbursement is crucial for hospitals. It fuels their ability to provide high-quality care, invest in cutting-edge technology, and attract skilled staff. The complexities of Medicare cost reporting, however, can lead to adjustments and a decrease in reimbursement, thus threatening financial stability.

Hospitals facing cost report underpayments often embark on a challenging Medicare appeals process. Stringent deadlines, precise discrepancy documentation, and well-supported arguments are all essential for success. However, navigating the legalities, reimbursement calculations, and intricate Medicare regulations can be overwhelming.

Besler Holdings’ experienced specialists alleviate this burden, simplifying hospital cost report appeals.

Don’t let Medicare reimbursement complexities hinder your ability to deliver exceptional care. Team up with Besler Holdings for a proactive approach to ensure your hospital receives its deserved Medicare reimbursement.

Medicare Cost Report Reopenings

There are a number of reasons a hospital might request a cost report reopening. Unlike cost report appeals, reopenings are pursued in relation to issues previously settled at the Provider Reimbursement Review Board (PRRB) or at the direction of Centers for Medicare & Medicaid Services (CMS). Although cost report reopenings are at the Medicare Administrative Contractor’s (“MAC”) discretion, Besler Holdings’ specialists have experienced success in pursuit of cost report reopenings on behalf of hospitals.

The specialists at Besler Holdings have worked extensively with MACs for more than 20 years. Our experience has allowed us to cultivate sound relationships with the MACs. This working relationship allows Besler Holdings to clearly articulate a hospital’s needs to the teams responsible for addressing them.

In addition to utilizing reopenings to address settled issues, another avenue a hospital can pursue to increase their reimbursement is through SSI Rebasing. Besler Holdings and its channel partner, Keyzer, Shelby and Associates, Inc., have the expertise in SSI policies helping to shape them and ensuring hospitals benefit from the latest changes.

The financial implications of SSI Rebasing can be substantial. The numerator of the Medicare fraction includes SSI days; therefore, a higher number of SSI days may translate directly into greater DSH payments. For hospitals with fiscal years that do not align with the federal fiscal year, rebasing ensures that the calculation includes all relevant patient days that occurred during their actual fiscal period. Our supporting processes promote efficiency and provide for success in the pursuit of SSI Rebasing.

We are well-versed in handling complex reopening matters, ensuring hospitals receive proper reimbursement. Contact us to learn more about our Medicare Cost Report Reopenings and Rebasing.