Hospital Reimbursement

Myers and Stauffer is experienced in Medicaid inpatient and outpatient hospital reimbursement issues. We have developed both fee-for-service and prospective payment systems for Medicaid programs throughout the country. Myers and Stauffer staff are currently providing hospital audit, rate setting and reimbursement system consulting support to government agencies. Our hospital reimbursement services include:

• Developing Diagnosis Related Groups (DRG) payment systems and calculating DRG weights and rates.
• Developing reimbursement methodologies for medical education costs (GME, IME, other).
• Desk review, audit and cost settlement of inpatient hospital services.
• Developing and maintaining inpatient hospital cost and statistical databases.
• Inpatient utilization monitoring and surveillance.
• Medical chart compliance auditing.
• Assisting in drafting inpatient hospital reimbursement regulations and state plan provisions.
• Preparing upper payment limit findings.
• Developing and calculating Disproportionate Share Hospital (DSH) payment plans.
• Providing expert testimony and other litigation support.
• Developing level of care payment methodologies for non-acute hospital services.
• Cost report verification of outpatient hospital cost consulting (desk reviews and audits) on outpatient reimbursement issues.
• Designing and working with prospective reimbursement systems for outpatient services (Fee Schedules, APGs, APCs, etc.).
• Database system development and analysis, including both cost and claims data.
• Preparing upper payment limit calculations.
• System maintenance and rebasing activities.
• Utilization monitoring and surveillance.
• Assisting in drafting outpatient hospital reimbursement regulations and state plan provisions.