Reimbursement and Consulting Services

  • Analysis of hospital inpatient and outpatient Medicaid rates
  • Medicare disproportionate share reviews
  • Development/implementation of reimbursement strategies under the Federal Upper Payment Limit Program
  • Development of reimbursement models for Medicaid disproportionate share funds
  • Rate analysis for nursing homes and other institutional providers
  • Revenue maximization reviews
  • Managed care rate reviews
  • Detailed claims reviews for compliance with Medicaid billing requirements
  • Fiscal impact analysis of legislative proposals
  • Responses to request for proposals or Invitations to Negotiate
  • Litigation support

Regulatory and Policy Related Services

  • State and Federal regulatory and reimbursement policies
  • Legislative health care strategic planning
  • Development of state plan changes for submission to the Centers for Medicare and Medicaid
  • Review and design of health plan anti-fraud and abuse measures