■ Review cost reports and QHR reimbursement
recommendations to ensure the hospital obtains
the government reimbursement it is due
■ Monitor and understand frequent changes in federal
regulations that impact the hospital’s CAH reimbursement
■ Comply with the CAH mandate of 96 hour annual
average length of stay and 25 bed limit, through
Case Management education and consulting that
transforms a basic Utilization Review and Discharge
Planning process into an expanded Case Management
System, including coverage in the Emergency Room
and Outpatient Surgery, and operational strategies to
manage multiple patient types, such as Inpatient,
Observation, Extended Recovery and Hospice within
a 25-bed limit.
■ Train their management team and department
heads to effectively manage within the CAH environment,
with customized education and training courses through
the QHR Learning Institute
■ Improve free-standing and hospital-based physician
practice operations and reimbursement
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■ With reimbursement tools to use in the hospital’s
annual cost report preparation and submission process
■ Conduct new product line costing and reimbursement
studies – cost-based reimbursement requires detailed
reviews of service additions, downsizing and capital
acquisition decisions
■ Review Medicare Advantage plans, assist with
contact negotiations and develop financial modeling
■ Improve Medicare cash flow through hospital-specific
Medicare contractual accounting models
■ Strategically set rates tailored to the local market and
CAH Medicare reimbursement |