Full-spectrum
reimbursement services
for hospitals.

We have the knowledge and experience necessary to ensure compliance with the regulations and to recover all reimbursement that the provider is entitled to. Consistent with our philosophy, we will not simply send you a request for information and file the reports from a distance.

We believe it is necessary to spend time on-site, interviewing your department heads and understanding the current environment of your organization. This ensures the cost report reflects actual operations and that your total reimbursement is reflective of the care provided to your Medicare beneficiaries.

The cost report is critically important even if you are not a cost-reimbursed provider — it is used to develop your cost-to-charge ratios that impact PPS payments, Medicare wage index, and DRG cost weights, and may also be viewed by external stakeholders who want to learn more about your hospital's community impact.

Strategic views the Medicare DSH add-on payment as a complex solution that isn't focused entirely on the level of Medicaid days and the SSI percentage. We recognize that uncompensated care costs and 340B eligibility are critical components to consider too.

The shift in DSH payments to focus more on uncompensated care than on Medicaid eligibility is significant — and is also a major focus for MAC auditors nationwide. Strategic will not only ensure that all eligible days are captured, validated, and properly documented, but we ensure that every opportunity to qualify for uncompensated care payments and the 340B drug savings program is also pursued.

Strategic has an experienced team dedicated to providing a comprehensive approach to preparing or reviewing Traditional, Cross-Over, and Charity Medicare Bad Debt logs. Our process ensures accurate logs in accordance with Medicare regulations and MAC requirements across the country.

Our team has extensive experience working with MACs nationally, helping clients meet the evolving procedural requirements necessary to ensure proper Medicare Bad Debt reimbursement — and defending those positions through audit if needed.

Accurate reporting of wage and benefit-related information on your cost report impacts a significant amount of Medicare payments for PPS hospitals. Strategic does not review your wages, benefits, contract labor, and home office information in isolation.

Our review incorporates benchmarking against other hospitals in your Core Based Statistical Area (CBSA) and other CBSAs throughout the country. We'll determine whether your reported labor information is consistent with competitors and in line with rising labor costs nationally. Strategic specializes in bringing together all hospitals in a CBSA to form a consistent approach — maximizing the wage index factor for everyone.

Every three years, Medicare requires hospitals to file an Occupational Mix Survey (OMS). The calculations are often misunderstood, and the impact is often significant. Unlike most consultants, Strategic reviews your OMS annually to assess whether adjustments are applicable — not just in filing years.

Strategic will provide a comprehensive square footage report of your facility, including all documentation required by the MAC and others. Using updated blueprints and/or CAD drawings, we'll measure every square foot and cross-reference it to every department in your general ledger.

With many overhead departments using square footage as a statistical basis, accurate departmental assignments are imperative to achieving proper reimbursement and maintaining a compliant cost report. Our study stands up to audit and reflects CMS requirements precisely.

It is becoming increasingly difficult for hospitals to recruit experienced reimbursement staff to oversee the constantly changing regulatory environment. Strategic has the experience and perspective to meet this demand. Many members of our team have led reimbursement departments, served on large health systems' operational and financial teams, or acted as chief financial officers.

Our focus in an interim capacity is not just the completion of routine work — it's supporting your organization's mission, senior leadership, internal and external audit support, month-end and year-end close, contractual allowances, and third-party reserve reporting. These services evolve constantly to meet your needs.

Time without proper reimbursement departmental leadership is costly. We help mitigate problems and ensure a smooth transition when you're ready to bring on permanent staff.

Increasingly complex and ever-changing federal and state healthcare laws have resulted in an array of litigation reaching as far as the United States Supreme Court. The Provider Reimbursement Review Board and Medicaid agencies continue to make navigating the avenues to resolution — through appeal agencies or judicial review — a challenging task.

Strategic will not only help you identify all areas that should be appealed, but will guide you through the entire process ensuring all necessary procedures are followed to protect your appeal rights. We handle the filings, manage the deadlines, pursue administrative resolutions, and retain legal counsel — committed to being at your side from the initial request for hearing until you receive proper reimbursement.

With federal policy changes arising from the ACA, DSH payments are now predominantly based on a hospital's level of uncompensated care costs. The reporting requirements placed upon hospitals are putting a significant strain on resources.

Strategic has a designated UCC team to monitor CMS's evolving interpretation of uncompensated care costs and provide guidance on reporting. Our proprietary work plan involves not just the finance team, but also patient billing and IT/decision support — ensuring the proper policies and procedures are in place to meet audit standards. We bring peace of mind that your uncompensated care costs are accurately identified, appropriately documented, and ready for audit.

It's increasingly important for hospitals to revisit internal policies and procedures as legislation changes. Without guidance, regulatory shifts can jeopardize reimbursement and create compliance exposure across multiple areas simultaneously.

Our involvement with hospitals across the country — in all spectrums of reimbursement — makes Strategic uniquely suited to provide this guidance. We help hospitals assess compliance, update internal processes, and build the institutional knowledge to stay ahead of regulatory changes.