R1 helped a medical center identify overlooked reimbursement opportunities
A medium-sized medical center serving a high Medicare disproportionate share hospital (DSH) population sought additional reimbursement opportunities from prior cost report years.
R1 reviewed 24 cost report years for retrospective Medicare DSH days and Supplemental Security Income Redetermination (SSIRD) opportunities.
The review required no internal hospital data, minimizing the burden on the medical center’s internal teams.
Situation
Medicare DSH reimbursement opportunity
As a medium-sized medical center serving a high Medicare disproportionate share hospital (DSH) population, the organization wanted to determine whether prior cost report years contained opportunities for additional reimbursement. It needed an efficient, low-risk approach to uncover potential net revenue without creating a significant burden for its internal teams.
Solution
Retrospective DSH and SSIRD review
R1 reviewed retrospective Medicare DSH days and performed Supplemental Security Income Redetermination (SSIRD) across 24 cost report years to identify additional reimbursement opportunities. The review enabled R1 to look across prior years for reimbursement that may otherwise have gone unrealized.
Performance highlights
$730K
in additional Medicare DSH reimbursement identified across nine fiscal years
$4.65M
in reimbursement delivered after expanding the engagement with R1
24 years
of cost reports reviewed for retrospective DSH and SSIRD opportunities
~180 days
typical settlement time for SSIRD reopenings
Outcome
R1’s retrospective review uncovered significant Medicare DSH reimbursement opportunities with minimal burden on the medical center’s internal teams. The initial results also led the organization to expand R1’s services to another system facility.
$730K in additional reimbursement
R1 identified an additional $730,000 in Medicare DSH reimbursement across nine hospital fiscal years. The results demonstrated the value of reviewing prior cost report years for reimbursement opportunities that may otherwise have gone unrealized.
Expanded engagement delivers $4.65M
Based on the initial results, the organization expanded R1’s services to an additional system facility. R1 ultimately delivered $4.65 million in reimbursement across 13 hospital fiscal years for DSH and SSIRD, displacing the organization’s original vendor.
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