R1 Uncovers $15.2M in Medicare Bad Debt Reimbursement

Situation

An 11-hospital health system knew it was leaving Medicare reimbursement on the table but lacked the staff to prove and recover it. With no reliable way to identify which accounts qualified for Medicare Bad Debt (MBD), and little bandwidth to track CMS’s shifting requirements, the organization needed a partner to turn that gap into real-time, defensible recovery.

Solution

Our Medicare Bad Debt team processed years of hospital data, with some cases dating back to 2010 for the larger hospitals still awaiting a Notice of Program Reimbursement (NPR). Our platform with proprietary technology helps organizations like the health system capture MBD, allowing teams to perform detailed testing of the applicable accounts according to CMS regulations. With our platform, only qualifying accounts make the final listings submitted for reopening or amendment.

For the hospital health system, we also provided full audit support to help those accounts withstand Medicare Administrative Contractor (MAC) scrutiny. In addition, we worked with the hospital team to build lasting best practices going forward.

Results

We reviewed all open cost report years for MBD across the hospital system and identified 89 years eligible for reopening or amendment. We helped uncover $15.2 million in net reimbursement, with a nearly 100% MAC acceptance rate.

The health system now relies on us as an ongoing safety net for filing, reviewing and adding new accounts before audits.