Reimbursement & Advisory

Our team can help you maximize reimbursements, protect margins and improve financial health.

Maximize today.
Anticipate tomorrow.

What strategies do you need to improve your margins and overall financial performance? What opportunities exist when you consider the market demand, regulations and demographics of the communities you serve?

Our HORNE team offers timely and relevant insights to help optimize reimbursements, protect margins and identify the best opportunities for growth. We evaluate your unique environment and look at the competitive forces to provide financial impact analyses and reveal the best strategies going forward.

Revenue Advisory

As fee-for-service reimbursements lessen, you need to project revenues under new payment models and identify new sources of revenue. Knowing your payer mix is just the beginning. You must examine how you use capital to generate return on investment and fulfill your mission.

We help you evaluate factors such as market demand for new services, as well as the cost and life span of the technology required to meet that demand. We provide recommendations designed to boost revenue and improve your overall financial strength while minimizing risk and exposure

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 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 Low-Volume Adjustments

Sole Community Hospitals and Medicare Dependent Hospitals qualify for additional payments based on Medicare low-volume adjustments. If reduced payments or increased 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.

Special Hospital Designations

Together we can evaluate whether you qualify as a Disproportionate Share Hospital, Critical Access Hospital 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.

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 Geographic Classifications

Your geographic classification impacts your wage index and 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.

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.

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.

Insights and
Resources

Market Dislocations: Bid-Ask Spread and Risk Premium in Healthcare

We have been hearing about a “bid-ask spread” issue in the lower middle market healthcare space for a significant time, and I wanted to discuss...

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

Each year around April or May, the Trustees of the Social Security and Medicare Trust Funds release their accounting of the current, short-term...

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Navigating the Healthcare Investment Market

With the first quarter behind us, we want to share some insights after talking with several healthcare investors since the beginning of the year....

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Designated Health Services Profits: Rules and Regulations

Effective January 1, 2022, the Centers for Medicare and Medicaid Services (CMS) implemented major changes to the Stark Law regulations. The Stark Law...

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

Private Equity, an exclusive asset class, attracts accredited investors due to its impressive returns and illiquid nature. It plays a significant...

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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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