Reimbursement
& Advisory
Improve revenue with accurate reimbursement.
HORNE’s reimbursement and advisory services are designed to help healthcare organizations navigate the complexities of reimbursement systems while enhancing financial performance. With decades of experience, our team offers you extensive insights into Medicare, Medicaid and other reimbursement models. Together, we can find innovative and effective ways to optimize reimbursements, protect financial margins and identify opportunities for improved efficiency.
Are You Leaving Reimbursements On The Table?
Navigating today’s complex reimbursement environment requires more than compliance — it takes insight, precision and a proactive strategy. HORNE Healthcare’s Reimbursement and Advisory team partners with providers to identify opportunities, reduce risk and strengthen financial performance. Whether you’re responding to regulatory change, optimizing cost reports or pursuing underpaid claims, we deliver the clarity and confidence you need to make every dollar count.
Our Reimbursement &
Advisory Services
Medicare & Medicaid Cost Reports
When preparing your report, we focus on optimizing reimbursements to protect your revenue streams from exposure. We review and analyze trends within the reports for opportunities to enhance revenue and position your organization for success today and in the future. In cases where appeals are warranted, we can expedite and assist in filing.
Medicare Volume Decrease Adjustments
Sole Community Hospitals and Medicare Dependent Hospitals qualify for additional payments based on Medicare volume decrease adjustments. If reduced payments and decreased patient volumes impact your business, we can assist you in the application process. Our goal is to help you cover fixed costs and gain your fair share of reimbursements.
Medicare Geographic Classifications
Your geographic classification impacts your Medicare reimbursements. Our team can help you appropriately adjust your classification to ensure you’re receiving the correct payment amounts. We review the required criteria and guide you through the next steps and can help file your application.
Medicaid Rate Optimization
Unlike Medicare, Medicaid fee schedules and reimbursements vary significantly from state to state. We examine the cost incurred for care and help you find compliant ways to distribute costs to ensure your reimbursement is optimized. By classifying expenses, adapting new cost-accounting techniques and making sure your processes are aligned with your state’s reimbursement parameters, we help make a measurable impact on your bottom line.
Special Hospital Designations
Together we can evaluate whether you qualify as a Disproportionate Share Hospital (DSH), Critical Access Hospital (SAH) or Sole Community Hospital. Your designation can significantly impact reimbursements and, ultimately, your bottom line. We help you with the details of applying for designation, leveraging our knowledge and experience with the Medicare system.
Supplemental Payment Optimization
How much of the care you provide currently is uncompensated? By identifying errors in documents, methodology and coding, we can help you find uncompensated care costs and apply for supplemental Medicaid reimbursements. We also explore supplemental funds available in your state (such as improving patient access) and help you find innovative ways to get the fair and full compensation for the care you deliver.
Wage Index Review & Occupational Mix Surveys
The occupational mix survey by the Centers for Medicare and Medicaid Services (CMS) directly impacts your wage index reviews. These complex surveys require an analytical and strategic approach to ensure data is accurate and consistent. By preparing and reviewing these surveys, we can ensure optimal reimbursement rates.
Patient Driven Payment Model (PDPM) Analysis
The move toward a Patient Driven Payment Model presents a radical shift in the way skilled nursing facilities address staffing, finances and the delivery of care. HORNE Healthcare can help you examine the impact that PDPM will have on your operations and help you prepare for a successful transition by exploring new revenue sources and optimizing your reimbursements under the new guidelines.
Community Health Needs Assessments
The Community Health Needs Assessment (CHNA) can be more than a regulatory requirement. We help you leverage insights gained to create a road map for your organization’s mission and engage community partners who share a stake in that mission. Together we can conduct a CHNA that meets regulatory guidelines, identifies community needs and creates community involvement and awareness.
Medicare Bad Debt Reimbursement
Gaps in reimbursement strategies cause you to lose millions of dollars in Medicare Bad Debt reimbursements each year. Staffing issues, new processes and government regulations all contribute to dollars falling through the cracks and going uncollected.
HORNE experts will partner with you to review every Medicare dollar reported in years past, verify where it went and what was lost.
Graduate Medical Education (IME/GME)
As CMS continues to refine policies around IME and GME reimbursements, teaching hospitals are challenged to adapt — balancing compliance, documentation and funding in an increasingly complex environment.
From capturing full-time equivalency to optimizing reimbursement opportunities, we’ll work with you to uncover potential funding gaps and strengthen your approach to IME/GME reporting and compliance.
Medicaid DSH Surveys
The Medicaid Disproportionate Share Hospital (DSH) survey process has become more complex, and hospitals are under increased pressure to ensure accuracy, timeliness and compliance.
From reviewing survey data for completeness to validating uncompensated care calculations, we work alongside your team to strengthen your compliance posture and protect every dollar your hospital is entitled to receive.
Medicare DSH Studies (Medicaid Eligibility)
Changes in state Medicaid policies, enrollment systems and CMS guidance have made it more challenging than ever to accurately capture Medicaid-eligible days — a key driver of your Medicare DSH payment and 340B Payments.
From validating eligibility across state systems to reconciling reported days, we work with your team to ensure your Medicare DSH study is thorough, accurate and fully optimized for the reimbursement your hospital has earned.
Clinical Integrated Network
Clinically Integrated Networks (CINs) are reshaping the future of healthcare — but creating a successful network requires more than shared goals. We help physician groups and hospitals design, implement and optimize CIN strategies that drive value-based performance, improve patient outcomes and ensure regulatory compliance.
Rural Healthcare Transformation
HORNE Healthcare partners with rural hospitals and clinics to transform care delivery, strengthen financial performance and navigate shifting reimbursement models. Whether you’re exploring new service lines, rethinking operational strategy or pursuing rural health redesign programs, we bring the insight and expertise to help your community thrive.
Bundled Payments
As value-based care accelerates, bundled payment models present both opportunity and risk. Success depends on aligning clinical care, managing costs and tracking outcomes with precision. HORNE Healthcare partners with providers to navigate the complexities of bundled payments — from opportunity analysis and program design to performance monitoring and financial reconciliation. We help you capture the full value of participation while improving care coordination and driving measurable results.
Value Based Care (VBC)
HORNE Healthcare helps providers design and implement value-based care strategies that improve outcomes, reduce costs and position your organization for long-term sustainability. From performance analytics to care model redesign, we’re your partner in building a smarter, more connected future of care.
