RSM Resources

How effective is your process for managing disproportionate share (DSH) reimbursement revenue streams? Many providers miss out on significant DSH reimbursement opportunities due to ineffective revenue cycle management strategies.

Regulatory recovery mattersare complex and often require specialized skills and an in-depth understandingof Medicare statistical audit techniques. There are several issues that oftencomplicate an organization’s ability to achieve appropriate levels of DSHreimbursement, including:

• Organizational strategiesthat do not maximize the full benefit of DSH reimbursement
• Complexities of Medicare DSHstatute and Medicare auditor documentation requirements
• Ineffective front-endprocesses for collecting critical patient data and multiple payer documentation
• Confusion regardingeligibility requirements
• Ineffective, inefficient andcostly back-end processes to recapture lost DSH reimbursement

How we can help
At RSM McGladrey, ourregulatory recovery services are designed to identify high-impact Medicare costreport-related opportunities, including Medicare DSH — Medicaid and Medicaresupplemental security income (SSI) proxies.

Our approach to regulatoryrecovery uses proprietary electronic processes to review all hospital patientrecords for Medicaid and SSI eligibility, and to identify internally missed DSHopportunities. To deliver an error-free report to your fiscal intermediary, wematch these electronic processes with manual Medicare-based mock audit processes.

Due to limitations of statedatabase search engines, we evaluate the patient population against applicablestate eligibility databases. This helps us pinpoint inconsistencies betweenstate eligibility databases and internal hospital data — often generatingadditional DSH reimbursement opportunities.

Because we’re committed tohelping your organization achieve optimum DSH reimbursement, we proposestrategic solutions to address existing revenue cycle process deficiencies andorganizational strategies.

And since the data used in aDSH recovery engagement can also help identify missed or omitted Medicarecrossover claim bad debts — omissions that often result in material errors — wehelp organizations use this information to accurately file their Medicare bad debts.