Reimbursement & Advisory

We help optimize reimbursements, protect margins and identify solutions to capitalize on opportunities to increase efficiency and profitability.

Optimize, protect and grow.

The long-term care industry faces many challenges. Reimbursements, changing regulations and market demands can present numerous obstacles to success. What opportunities exist to ensure your organization can serve your community for years to come?

HORNE’s healthcare team provides clinical and financial insights to help optimize reimbursements, protect margins and identify solutions to capitalize on opportunities to increase efficiency and profitability.

Medicare & Medicaid Cost Reports

When preparing your report, we focus on optimizing reimbursements to protect your revenue streams from exposure to regulatory sanctions and denials. We review and analyze the clinical and financial trends within the reports for opportunities to enhance revenue and position your organization for success in payment models today and in the future. In cases where appeals are warranted, we can expedite and assist in filing.

Certificate of Need Consulting

Numerous states require a Certificate of Need (CON) before approving the construction of any new medical facility. While this helps avoid redundancies within markets, it can also present an obstacle to growth. HORNE Healthcare can assist you in preparing a CON application with all required documentation and work with your internal team to ensure that all state requirements are met.

Market Demand Analysis

What is the true demand for your services in your existing or planned markets? When will a market reach saturation? What areas are being underserved? We can offer a detailed analysis —whether being performed to meet state requirements or to guide your plans for growth — of the opportunities presented by any given market area.

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.

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.

Telehealth Consultation

According to some estimates, 70% of all ER and PCP visits could be adequately handled via a telehealth consultation. Driven by cost, convenience and regulations, telehealth is destined to grow dramatically in the coming years. Through our partnerships with technology providers, HORNE Healthcare can help you reduce costs and improve care by developing a telehealth strategy for your facilities.

Insights and
Resources

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The Good, the Bad, and the Uncertain News of the 2024 Medicare Trustees Report

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Navigating the Healthcare Investment Market

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Designated Health Services Profits: Rules and Regulations

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Comparison of Private Equity-Type Transactions versus Hospital-Type Transactions

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Adapting FMV Physician Compensation to CMS MPFS Changes

CMS updates MPFS rates, impacting physician compensation. Recent changes demand healthcare entities stay current to avoid FMV...

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Acceleration & Growth

HORNE’s acceleration and growth services help you stay ahead of the change with our technology, people, process and experience solutions.


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