State Payment

DHCG is experienced in several states' Medicaid models for reimbursement and we work with respective Medicaid payment agencies and reporting requirements in those states.

Our firm's involvement in the state DSH application, appeal and UPL processes for our acute care and Children's hospital clients offers an integrated and strategic approach for State DSH and supplemental payments. We communicate routinely with representatives at the state level and various health industry related consultants to insure the information provided to our clients is both timely and as complete as possible.

State Disproportionate Share Payment

More specifically to the Texas reimbursement programs and Medicaid payments, we routinely work with clients in the evaluation of the state Disproportionate Share payments (DSH). DHCG prepares and evaluates certain payment models and to the extent that the facility meets the qualifications for the state DSH payment, we assist in the completion and filing of the recently revised and expanded state DSH application and the State DSH appeal process. A large part of the filing for the state DSH application and appeal cycle entails a more detailed evaluation of Medicaid cost, charges and uncompensated care dollars and adjudicated Medicaid claims to ensure for the correct and complete DSH and UPL payments.

Our Comprehensive State DSH services include:

  • DSH application compilation and filing
  • DSH application modeling tool
  • DSH claims appeal through our proprietary software tool
  • Assessments of data capture for charity and uninsured
  • Support for supplemental data and DSH audits
  • Provider representation and support throughout the DSH appeal and audit process
  • Assistance with future state claims' adjudication and data capture processes
  • Timely feedback and updates on State and Legislative developments
  • Strategies for state and federal rules and regulations

Private Hospital Upper Payment Limit Program

With the enactment of legislation in 2005, the state adopted an additional payment provision to capture some of the Medicaid shortfall in providing indigent care for private hospitals. The Medicaid private hospital Upper Payment Limit provides for additional state federal matching dollars to help alleviate some of the burdens of providing care to the medically indigent patients. DHCG works with many of the state's private hospitals to ensure compliance with the legislation with respect to the private hospital UPL program.

We have been integrally involved with our clients and state contacts in the UPL process with the forthcoming 1115 waiver changes as well. Additionally, we work with several Children's hospitals and their UPL programs.