Reimbursement & Advisory

Reimbursement & Advisory

Healthcare

Maximize today, anticipate tomorrow.

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As you evaluate various payment models, how do you anticipate the impact on your revenue streams? What strategies do you need in place to maintain or improve your margins and overall financial performance? What opportunities exist when you consider the technology, regulations and demographics of the communities you serve?

At HORNE, our healthcare team offers timely and relevant insights on how to optimize reimbursements, protect your margins and identify the best opportunities for growth. We’ll evaluate what’s happening in your unique environment and look at the competitive forces, providing financial impact analyses that lets you determine the best strategies to move forward. Our goal: offer solutions that position you to serve your community in an effective way for generations to come.

Meet Our Healthcare Team

“It all comes back to where is the revenue stream coming from, and how can we help our clients adapt the delivery of care in a way that they will be able to maximize their revenue potential going forward.”

Take advantage of our broad range of Reimbursement and Advisory solutions.

Revenue Advisory
As fee-for-service reimbursements flatten out, you need to understand and project revenues under new payment models and identify new sources of revenue. Knowing your payer mix is just the beginning. To enhance revenue and mitigate losses, you must go deeper to examine how you use capital to generate return on investment and fulfill your mission.

Throughout this strategic exercise, we’ll consider factors such as market demand for new services, as well as the cost and lifespan of technology required to meet that demand. In the end, you’ll receive a recommendation designed to improve your financial strength overall.

Medicare and Medicaid Cost Report Preparation and Review
Our report preparation focuses on optimizing reimbursements to protect your revenue streams from exposure to regulatory sanctions and denials. We’ll also look at the clinical and financial trends within the reports themselves for opportunities to enhance revenue and position your organization for success in payment models today and in the future.

Medicare Low Volume Adjustments
Sole Community Hospitals (SCH) and Medicare Dependent Hospitals (MDH) qualify for additional payments based on criteria for Medicare low-volume adjustments. In the event of reduced payments or increased patient volumes, we assist with the application process to help you cover fixed costs and gain your fair share of these reimbursements.

Special Hospital Designations
Our healthcare team can evaluate whether you qualify as a Disproportionate Share Hospital, Critical Access Hospital or Sole Community Hospital and determine the impact that designation has on your reimbursement and, ultimately, your bottom line. We help you apply to receive the designation so you can focus on your hospital’s mission.

Community Health Needs Assessments
The Community Health Needs Assessment (CHNA) is far more than a regulatory requirement. Leverage insights gained from developing community health improvement strategies to create a road map to fulfill your organization’s mission, while engaging community partners who share a stake in that mission. We partner with you to 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, which ultimately affects your Medicare reimbursements. Geographic adjustments ensure you’re receiving the right amount of payments for your area. Our experienced team can help you determine the best options and strategies for reclassification. We’ll help review the criteria needed, guide you through the next steps and even help file your application.

Wage Index Review and Occupational Mix Surveys
The occupational mix survey by the Centers for Medicare and Medicaid Services (CMS) directly impacts your wage index reviews. To ensure your wage index is set at the optimal levels, you’ll want to ensure a thorough review of your cost reporting and other factors. The surveys are complex and require an analytical and strategic approach to ensure data is accurate and consistent in reporting. We prepare and review these surveys to ensure a proper basis for optimal reimbursement rates.