Reimbursement Services For Prospective Payment System Hospitals
QHR has guided hospitals through Prospective Payment System (PPS) reimbursement since the system
was introduced to hospitals over 20 years ago. We help hospitals accurately report and receive deserved
reimbursement from Medicare and Medicaid payors. Our services include:
CONTRACTUAL ACCOUNTING REVIEW
Reviews the contractual accounting processes, allowances and cost report settlements as reported on financial
statements. This review helps hospital executives accurately present financial statements to the Board. Contractual
accounting models can be developed and customized for use in the hospital’s information system.
END STAGE RENAL DIALYSIS (EXCEPTION PAYMENT REQUEST)
Determines whether hospital can qualify for ESRD payment adjustment and if so, assist hospital file for payment
adjustment with CMS.
REIMBURSEMENT ADVISORY & LEGISLATIVE UPDATE
Explains legislative and regulatory changes in reimbursement in terms you can understand, and indicates the impact
of these changes on hospitals. This email resource is distributed on an as-needed basis.
REIMBURSEMENT & COST REPORT STUDIES
Reviews cost report for accuracy and compliance with current regulations. The analysis also identifies reimbursement
opportunities available to the hospital. Other studies include:
■ Disproportionate Share Hospital (DSH)
Reimbursement Study: Reviews claimed DSH
reimbursements on current and settled cost
reports.We develop methods to track “Paid Medicaid
Days” and other days included in DSH formula.
■ Medicare Bad Debts Review: Reviews bad debts
claimed on Medicare cost report and reviews
internal PFS functions to identify Medicare bad
debts that may have not been claimed on the
hospital’s annual Medicare cost report.
■ Medicare Dependent Hospital Designation:
Determines hospital qualification as a Medicare
Dependent Hospital and if so, provides
application assistance and reimbursement
benefit. | ■ Sole Community Hospital Designation:
Determines hospital qualification as a Sole
Community Hospital and if so, provides application
assistance and UPL (upper payment limits)
reimbursement benefit.
■ State Disproportionate Share Hospital (DSH)
Payment Application and Payment Review:
Reviews data submitted to the respective state
for DSH reimbursement for accuracy,
completeness, and compliance with state
regulations. |
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For more information on QHR Healthcare Finance & Reimbursement, contact:
Ken Venuto, Practice Leader, 214-473-3780.
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105 Continental Place | Brentwood TN 37027 | 1-800-233-1470 | | | | |  |
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