Disproportionate Share: The Opportunity & The Challenge
Since 1986, Medicare has allowed hospitals that serve a disproportionate share of low-income patients to claim additional reimbursement to offset payment shortfalls. Creating a valid Disproportionate Share (DSH) claim and maximizing the reimbursement opportunity involves significant patient-specific data analysis, detailed knowledge of applicable Medicare regulations and intermediary audit requirements, and an understanding of the Medicaid enrollment rules by jurisdiction. Substantial time and effort, and significant information systems capabilities, are necessary ingredients for success.
RSG Inc. – How We Respond To The Challenge
DSH reimbursement is based on the summation of two ratios: the Medicaid ratio and the SSI ratio. RSG Inc. provides services to ensure that both of these ratios are accurately calculated. These services include:
- Medicaid Eligible Days – RSG Inc. captures and documents every eligible day associated with the Medicaid ratio. Our process includes categorization of all inpatient cases, comprehensive electronic data matching and detailed manual research to reconcile every inpatient case.
- SSI Realignment – RSG Inc. analyzes your SSI detail provided by your Fiscal Intermediary to determine if an SSI ratio realignment would be beneficial to your institution. RSG Inc. files the appropriate documentation and provide support through the audit process.
- SSI Ratio Challenge – RSG Inc. helps your hospital prepare for potential recalculation of historical SSI ratios. We can provide the analytical, audit, and legal support to ensure that your institution received the appropriate reimbursement for past fiscal years.
For all three of the service offerings above, RSG Inc. provides full documentation, quality assurance and expert audit support.
What Makes RSG Inc. Different?
Using a unique methodology, we combine electronic data warehousing, information analytics and unmatched reimbursement expertise to produce the best possible results that yield an average 97 to 100 percent audit acceptance rate.
Our in-depth experience with patient accounting systems facilitates the capture and control of patient accounting and remittance data to analyze potential Medicaid-eligible days that should be included in the Medicaid ratio calculation. Accounts are run through our eligibility interface to identify all potential inpatient days. This process is supplemented with account-by-account research and a detailed internal Q/A protocol. The result is a highly accurate list of incremental Medicaid days.
Our proprietary analytical system ReAP (Reimbursement Analyst Platform) is our unique portal into the data storehouse that we create for each client. We have the ability to analyze your data and create standard reports needed for Quality Assurance and auditor requests.
Over 160 providers nationwide have chosen RSG Inc. for their Medicare-related reimbursement services. To date, we have recovered over $200 million in additional Medicare reimbursement on behalf of our clients. Our expertise spans every facet of a successful project: from source data acquisition, Medicaid eligibility analysis, quality assurance, documentation, and audit negotiation and support.