Assessments of

Wage Index & Occupational Mix

TPR's management team has successfully directed numerous wage index projects for Core Based Statistical Areas of all sizes. In the past 3 years we have completed projects for over 200 hospitals in 48 CBSA's.

• We utilize a “Turn Key” approach and methodology to assist clients file accurate and compliant wage index and occupational mix data.
• We have Wage Index specific experience with most fiscal intermediaries.
• TPR has experience with testifying in front of the Provider Reimbursement Review Board on wage index issues.
• TPR can provide Medicare geographic reclassification application assistance and advisory services.

DSH

TPR's management team can be credited with the initial development of a big four accounting firms DSH program. This initial experience has been developed and expanded to provide clients with un-paralled experience in capturing Medicaid eligible days for Medicare DSH reimbursement.

• We use a “Turn Key” approach and methodology to help clients assess the opportunity for additional Medicare DSH revenue and compliance with current Medicare regulations.
• TPR utilizes advanced IT data procedures and advanced technology such as ACL (Audit Command Language) to explore and accurately capture these DSH opportunities.
• We have experience with DSH assessments at hospitals of all sizes and complexities. Our team has performed over 150 engagements that have generated over $100 million in additional reimbursements for clients.

Managed Care Reimbursement Strategies

TPR's Medicare Advantage service assists providers with ensuring they are receiving the proper reimbursement from the entire spectrum of Medicare HMO payors. The Medicare Part C program was designed to give recipients choices other than traditional Medicare coverage that might offer plans that fit a specific lifestyle. While Medicare allows these plans to cover its recipients, it also mandated that providers receive the same reimbursement as if the recipient was covered under Medicare.

It is our experience that there are several cost report calculations and pass through payments that may be claimed in the cost report as well as outside of the cost report.

• TPR can to send a team of our experienced Managers/Directors to review language in your managed care contracts to determine if opportunities exist and are recoverable.
• TPR can investigate strategies which include Bad Debt, IME/GME, Allied Health, and Post-Acute Transfer DRG Recovery
• TPR can also quantify the reimbursement opportunity prior to our engagement.

Medicare Post Acute Care Transfer

The TPR team has developed a proprietary methodology to analyze whether or not health systems are being underpaid for claims that fall under Medicare's Post Acute Care Transfer provisions.

• The Centers for Medicare and Medicaid Services (CMS) regulations contain a payment policy referred to as the "Post acute Care Transfer Rule". CMS has identified Medicare DRGs that fall within the Rule which reduces DRG payments based on the length of stay and discharge disposition. The rationale is that hospitals should not receive full DRG payments for Medicare patients discharged to post-acute care settings when a portion of the acute care is provided by another facility.
• TPR has developed an audit proven methodology to assist hospitals assess the potential opportunity to re-bill for claims that were incorrectly paid as a Transfer at a reduced payment rate.

Nursing & Allied Health Programs

Since a 1999 CMS ruling, hospitals have been eligible for additional payments for the costs associated with running a nursing and allied health program. Approved nursing and allied health education programs that meet certain criteria are eligible for these additional payments. The management team of TPR solutions has recognized many hospitals that are eligible for these additional payments and have not taken advantage of the opportunity.

• TPR can validate and prioritize which cost reports are available for re-opening and/or amendment based on Notice of Program Reimbursement (NPR) dates and status of the fiscal intermediary's audit of each cost report fiscal year.
• TPR can determine the applicability of the strategy for all available cost reporting periods by performing detailed analysis of the current treatment of the variables impacting the additional reimbursement.
• TPR can quantify the estimated reimbursement impact for each cost report year available.

Medical Education – IME & GME Regulatory Support

There have been many changes and clarifications in regards to allowable reimbursement for IME and GME Programs. TPR fully understands these policies and procedures and can help your program fully protect its revenue stream.

• We provide medical education audit assistance to help programs accurately track allowable IME&GME days.
• We provide audit assistance to help programs accurately document resident data files necessary for inclusion in the IME&GME programs.
• We provide advisory services to help programs implement “best practices” to minimize any problems should their programs be audited by the Fiscal Intermediary.
• We are versed in and utilize the latest IT procedures to accurately capture and record your allowable days.

Organ Acquisition & Transplants

TPR's cost report organ acquisition cost review is a comprehensive assessment of the Transplant Center's (Center) utilization of the cost report and the related rules and regulations that govern how transplant acquisition costs are claimed on the cost report. Medicare organ acquisition cost centers are vital to the financial viability of any Medicare-approved Transplant Program. For a transplant Center to compete in today's marketplace, it must account for all allowable direct and indirect expenses to the appropriate Medicare Organ Acquisition cost center(s). In addition, appropriate and effective systems are essential to support the Medicare Organ Acquisition cost center(s) for the single or multi-organ Medicare-approved Transplant Programs(s).

TPR's management staff have a combined 36 years of Medicare reimbursement experience to determine the effectiveness of the systems and mechanisms that support and feed the direct and indirect costs needed to complete the Center's organ acquisition cost report claim completely and effectively to ensure the right reimbursement to the facility.

Medicare Organ Acquisition Center Analyses and Plans typically include but are not limited to the following:

• Personnel Expense Review
• Non-Salary Expense Review
• Operational and Functional Program Review
• Analysis of relationships and accounting of OPO transactions with the Center
• Indirect cost analysis and Statistics used to accomplish allocations
• Perfection of Transplant Recipient and Donor Costs
• Review and Analysis of Filed Medicare Cost Reports
• Model of proposed New Medicare Organ Acquisition Cost Report(s)
• Final Report of All Findings and Recommendations

TPR audit reports will discuss specific issues found in each of the Organ Acquisition cost reports to Medicare with details to be used by your Center to file amended Medicare Organ Acquisition cost reports for the purpose of capturing under-reimbursed fees and expenses as well as to correct overstated items and take appropriate corrective action with CMS/Medicare.

End Stage Renal Disease (ESRD)

TPR's management team has successfully directed ESRD engagements that have resulted in additional Medicare revenue for clients.

• Medicare ESRD beneficiaries admitted to hospitals for inpatient services with a primary diagnosis other than renal failure, renal dialysis or kidney transplant continue to receive dialysis treatments while in the hospital and are reimbursed pursuant to the appropriate MS DRG rate. For hospitals that treat a high percentage of Medicare ESRD beneficiary discharges, the Medicare regulations provide for an additional payment if certain thresholds can be met.
• TPR has an audit proven approach to assist hospitals assess the opportunity to qualify for the additional ESRD Medicare reimbursement. If our initial assessment indicates that your hospital may qualify for the additional ESRD reimbursement, TPR will assist your facility compile the appropriate supporting documentation to be submitted to the fiscal intermediary for consideration.

Bad Debts

TPR has the expertise and experience to guide providers though the complexities surrounding allowable Medicare bad debts.

• TPR can help hospitals with their bad debt policies and procedures and can help your organization be compliant with the somewhat fluid interpretation of allowable Medicare bad debts by the fiscal intermediary.
• To avoid Medicare bad debt denials, TPR can help health care organizations review their bad debt policies to ensure they are compliant with the regulations outlined in the Medicare Provider Reimbursement Manual (PRM).
• TPR has developed a comprehensive methodology and an innovative software query to assist hospitals identify, automate, and document Medicare eligible bad debts.

Third Party Reimbursement Due Diligence

TPR has the technical expertise and experience to assist your management team. We can help your organization assess opportunities and / or exposure pertaining to hospital reimbursement prior to the acquisition of another provider.

• We can provide detailed analysis of prior period Medicare and Medicaid audit adjustments to ensure there are no surprise settlement issues in open cost report years.
• We can evaluate contractual allowance accounts to ensure third party contractual balances are adequate and reasonable.
• We can analysis all of your key Medicare and Medicaid reimbursement areas to identify potential prospective and retrospective reimbursement opportunities.
• We can assess and test your Hospitals policies and procedures pertaining to Medicare cost report preparation and third party cost report and contractual reserves.
• We can analysis your Hospitals third party reserve “roll-forward” schedules for completeness and reasonableness.