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| Retroactive opportunity nets $24 million in DSH payments |
THE SITUATION
A large, Midwestern health system underwent an ambitious period of growth in the 1990s, integrating numerous facilities into a single, centrally managed system. As a result, the system achieved many efficiencies, but qualifying for Medicare Disproportionate Share revenue proved elusive: four of their largest hospitals repeatedly fell just below the Disproportionate Share threshold, missing out on at least $4.5 million annually in Disproportionate Share funds.
THE SOLUTION
RSG Inc. partnered with the system to compile Disproportionate Share documentation for all the hospitals dating back to fiscal year 1992. As part of our approach, RSG Inc. integrated patient service data going back to 1990, as well as all Medicare and Medicaid payment information for both inpatient and outpatient accounts. In addition, we developed an electronic interface with the state Medicaid agency to obtain eligibility information for the Disproportionate Share listings. This verification process helped to ensure the integrity of the listings that we produced.
THE RESULTS
Over $40 million has been approved for payment, representing an audit acceptance rate of 97 percent.
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