Case Studies

Medicare Reimbursement Increase & Cost Report Appeals Management

J.S. Held’s Inaugural Global Risk Report Examines Potential Business Risks & Opportunities in 2024

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The Situation

A major not-for-profit health system wanted to improve its reimbursement associated with the Medicare Disproportionate Share Hospital (DSH) program. The client was also seeking a partner to manage its Medicare Cost Report Appeals by monitoring its Notices of Program Reimbursement (NPRs), preserving appeal rights, filing preliminary position papers, and working with outside counsel in the pursuit of the appealed cost report claims.

How We Advised

J.S. Held experts:

  • Developed a robust and comprehensive Medicaid days verification process
  • Used findings from Medicaid verification and worked with the client to file updated reports
  • Represented the client during Medicare Cost Report Audits and reviewed auditor findings to ensure proper payment
  • Developed an appeals process that included monitoring NPRs, identifying issues, and preserving appeal rights
  • Worked with counsel to resolve appeals

Ultimately, the health system realized millions of dollars in additional Medicare DSH reimbursement. They also implemented the recommended process for as-filed Medicare Cost Reports resulting in improved cash flow, and numerous appeal issues were preserved and successfully resolved, resulting in increased Medicare reimbursement.

Key Contact

Magi Curtis
Executive Vice President
Healthcare Consulting
+1 615 626 0023
[email protected]

Related Practice Areas

> Healthcare Organizational Transformation
We partner with healthcare leaders to optimize performance, drive value creation, accelerate innovation, and strategically position themselves for growth. We serve as trusted advisors to healthcare leadership to develop organizational strategies that are informed by business intelligence and enable tactical execution.

> Risk & Advisory
We help clients maximize business value and minimize risk. Our risk and advisory experts offer insights and analyses that enable our clients to make informed business decisions and help resolve commercial disputes.

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