Case Studies


RSG Inc. helps to produce nearly $30 million in sustainable Medicare Bad Debt reimbursement

THE SITUATION

As a result of a recent merger of numerous facilities, a large urban healthcare system was faced with streamlining the development of Medicare Bad Debt logs across all its hospitals. Prior to the merger, each facility had followed its own unique methodology with varying degrees of success. In fact, several of the larger hospitals were experiencing complete failure at audit, primarily due to improper documentation.
Faced with merger-related constraints and staff reductions, the Health System turned to RSG Inc. to consolidate the data and provide standardized procedures in order to produce accurate and sustainable Medicare Bad Debt logs, and recoup the associated revenue.

THE SOLUTION

Because the hospital retained paper Medicare/Medicaid remits instead of electronic records, RSG Inc. sorted and electronically recorded the hundreds of boxes of remittances containing millions of records. Once this database was in place, we were able to reconcile the Medicare and Medicaid data in order to identify valid balances as Bad Debt for each hospital within the Health System.

THE RESULTS

As a result of our efforts, RSG Inc. helped the Health System produce over $30 million in audit sustainable Medicare Bad Debt logs, including accounts with dates of service up to six years prior.


 

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.