Reimbursement Consulting

We provide payor negotiations and contracting services in addition to chargemaster reviews. LBMC has been a recognized firm in healthcare consulting for over 20 years. Our dedicated healthcare industry team provides a wide range of services, including cost report preparation and review, and reimbursement consulting services for both cost-based and PPS providers. We understand the importance that cost reporting and reimbursement hold for healthcare entities and offer a wide variety of services to help you reach your goals.

Our unique partnership approach enables healthcare providers to anticipate potential changes in reimbursement rates by proactively monitoring operational changes throughout the year, eliminating rate setting surprises. We also provide chargemaster reviews and strategic pricing adjustments to meet today’s need for more transparency in healthcare pricing.

LBMC Healthcare Consulting provides a wide variety of services including:

Cost Reporting Services

  • Preparation and/or review of Medicare and/or Medicaid Cost Reports.
  • Review and assistance with tentative settlements, cost report audits, appeals and other correspondence with CMS and MACs.
  • Review of previously filed cost reports in order to identify potential exposure and reimbursement opportunities.
  • Compilations or independent review of various Medicaid and other State Program Reports such as Residential Treatment Centers.

Payor Contracting and Negotiations

  • Chargemaster Reviews
  • Review all current contracts for compliance, performance and renegotiate with payors, as appropriate, to obtain more favorable contract conditions and/or rates.
  • Review all new contract proposals and recommend acceptance or denial, based on potential performance and fit with the group’s strategy and goals.
  • Review payor market shares in your area and new contract recommendations.
  • Provide telephone and email support to your staff on questions related to payor contracts.
  • Provide ongoing monitoring of contracts for payor compliance.
  • Project environments: Hospitals, ASC, Rehab, Psych (inpatient and outpatient), Physicians (hospital and non-hospital based) and Ancillary services.

Consulting Services

  • Identify and assist with opportunities for Disproportionate Share (DSH) and Low Income (LIP) reimbursement for medical/surgical and rehabilitation hospitals, respectively.
  • Assist in compiling and/or review of traditional Medicare Bad Debts and Medicaid “crossover” Bad Debts.
  • Square Footage Analysis for proper cost allocations.

Other Reimbursement Services

  • Assist with Wage Index audits and review for potential Geographic reclassifications.
  • Consultations for various Provider based issues.
  • Assistance with completion and filing of occupational mix surveys.
  • Due diligence to assist with opportunities and liabilities with acquisition/merger activities.

Types of Clients Served

  • Acute care hospitals (ACH)
  • Behavioral health hospitals (BHH)
  • Critical access hospitals (CAH)
  • Dialysis centers
  • Federally qualified health centers (FQHCs)
  • Home health care
  • Home offices
  • Hospice facilities
  • Long-term care hospitals (LTCH)
  • Nursing homes
  • Physician practices
  • Rural health clinics (RHCs)
  • Skilled nursing facilities (SNFS)

Reimbursement Consulting Leadership

Link to Andrew Reimbursement Consulting

Andrew McDonald, FACHE

Shareholder, Practice Leader Physician Business Solutions, LLC and Healthcare Consulting

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