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Health Care Reimbursement and Advisory Services

HORNE's health care reimbursement and advisory team has substantial experience in financial, strategic and operational matters from both a hospital system perspective and a physician perspective, an essential approach in the current environment.  HORNE offers comprehensive services for clients related to reimbursement and health care operations:

• Medicare, Medicaid and Other Government Cost Report Preparation
• Medicare/Medicaid Disproportionate Share (DSH) and Low Income (LIP) Reviews
• Post acute transfer studies (DRG Transfers)
• Wage index review and occupational mix surveys
• Geographic reclassifications
• Medicare low volume adjustments
• Low volume payment adjustment requests
• Financial operations review and management consulting
• Community health needs assessment

Medicare, Medicaid and Other Governmental Cost Report Preparation
HORNE provides cost reporting services for various provider types throughout the nation.  Our services include preparation and review of the cost reports, assistance in compiling Medicare bad debts, assistance with tentative settlements, in addition to numerous other cost reporting matters. 

Medicare/Medicaid Disproportionate Share (DSH) and Low Income (LIP) Reviews
Comprehensive summary reports are part of HORNE's DSH and LIP studies.  These reports include Medicaid exhausted days, out-of-state Medicaid eligible days, and revised DSH and LIP calculations for inclusion on the provider's original or amended Medicare cost report.

Post Acute Transfer Studies (DRG Transfers)
By partnering with an established data clearinghouse, HORNE reviews transfer DRGs for potential coding misclassification.  The process includes review of all relevant claims identification of recovery opportunities, provision to the hospital of claims to be adjusted, and verification of acceptance of the corrected claim after the hospital adjusts the claims.

Wage Index Review and Occupational Mix Surveys
HORNE's wage index review includes review and analysis of payroll summary reports, re-classification and adjustments of salaries as needed, and confirmation of cost capturing.

Geographic Reclassifications
HORNE assists facilities in determining eligibility for reclassification to use the requested area's wage index.  This applies to hospitals that want to be reclassified from a rural area to an urban area, from a rural area to another rural area, or from an urban area to another urban area. 

Medicare Low Volume Adjustments
Medicare low volume adjustments are available to both Sole Community Hospitals (SCH) and Medicare Dependent Hospitals (MDH).  HORNE's reimbursement and advisory team can help you determine if your hospital meets the initial criteria for this adjustment, as well as assist you throughout the application process. 

Low Volume Payment Adjustment Requests
HORNE assists facilities with the compilation of required information to request a low volume payment adjustment as allowed by the PPACA. The HORNE team completes the application based on the regulatory criteria and conditions provided by federal regulations.

Financial Operations Review and Management Consulting
HORNE's financial operations reviews and management consulting services include reviewing cash conversion, reviewing accounts receivable processes, reviewing service line profitability on a macro level and pinpointing obvious gaps that may have areas for improvement. HORNE also analyzes the legislative impact of PPACA on your facility.

Community Health Needs Assessment
HORNE works with hospitals to conduct a community health needs assessment (CHNA). The assessments comply with federal requirements and include: input from a broad interest in the community; are made widely available to the public; provide an implementation strategy to meet and report on the needs not met and reasons for the gaps.

For more information on HORNE's health care reimbursement and advisory services, contact Partner David Williams at 601.326.1320 or by email at david.williams@horne-llp.com.