Regulatory and Reimbursement Services


These services can range from compilation and assembly services to in-depth review and compliance testing. We can also perform preparation assistance only for specific areas of the cost report, such as areas described below as complex issues. Certain specific areas may warrant detailed compliance reviews based on the amount of financial and compliance risk.


This type of service is focused on reviewing your internal preparation processes, with an emphasis towards compliance with Medicare / Medicaid regulatory standards and audit guidelines.


This is a focused review of specific reimbursement areas, primarily related to areas subject to retroactive adjustments, such as Disproportionate Share (DSH) and Bad Debt, Graduate Medical Education (GME / IME), Organ Procurement Cost, and cost based services for Cancer and Critical Access Facilities. For Cost Based Entities all of the cost report is believed to be a Complex Issue warranting intensive services.


While we would prefer for all hospitals to receive their reimbursement accurately the first time, around we realize that many times an appeal or reopening, or request for an exception payment may be the only way to receive the reimbursement that a provider is due. These services are structured as a fee arrangement if the item is not subject to regulatory audit and review or on a contingent basis if the item is subject to a final regulatory or administrative determination. This will be done in a manner that is in compliance with standards promulgated by most state Boards of Public Accountancy as appropriate contingent fee services, if we perform attest functions.