Challenge
A large three-hospital academic medical center suspected it had suboptimal Medicare Disproportionate Share Hospital (DSH) reimbursement value. The medical center was looking to maximize both retroactive and prospective DSH reimbursement.
Solution
R1 was initially engaged by the medical center for the optimization of retrospective DSH reimbursement. R1 analyzed five hospital fiscal years for each of the three hospitals. R1 Disproportionate Share Hospital helped the medical center maximize reimbursements using powerful analytics while providing complete and accurate DSH listings that withstood the scrutiny of Medicare Administrative Contractor (MAC) audits.
The entire project was implemented and completed in 90 days, including delivery of findings and amended report filing.
Results
The medical center was so pleased with the initial results that they expanded the scope to include an additional 14 hospital fiscal years. R1 identified DSH reimbursement of $13.6 million for all 19 hospital fiscal years and achieved a 99.8% acceptance rate on findings. Ongoing engagement with the medical center includes the addition of R1 Worksheet S-10 and the annual filing of prospective Medicare reimbursements.
Financial
More than
$13.5M
recovered in first two years
Operational
Up to a
99.8%
acceptance rate of findings
