Pursuing Enhanced Federal Reimbursement

The federal government, mostly through Medicare, reimburses different providers in different ways for the services they deliver to their patients. Even small, seemingly minor changes in how Medicare looks at a provider can result in significant changes in a provider’s Medicare revenue.

The key to changing how the federal government treats providers is always data – data that DeBrunner & Associates can provide.

Medicare area wage index classification has an enormous impact on hospitals’ Medicare payments. DeBrunner & Associates can generate data that enables hospitals to determine whether they qualify for reclassification; that shows the relative benefits of different reclassification options; and that supports reclassification applications.

Medicare has several categories of hospital types, each of which has specific qualifying criteria.  DeBrunner & Associates can generate data or help hospitals analyze their own data to determine whether they qualify for a new status that would result in enhanced Medicare payments – and also generate data to support applications for a change in provider type.  Those hospital types are:

  • rural referral centers
  • Medicare-dependent hospitals
  • small rural hospitals
  • sole-community hospitals
  • low-volume hospitals
  • critical access hospital

The federal 340B prescription drug discount program enables qualified providers to receive significant discounts on prescription drugs. Among the types of providers eligible for these discounts based on selected data are:

  • DSH hospitals
  • children’s hospitals
  • rural referral centers
  • sole-community hospitals

Applications for eligibility begin with data – data that DeBrunner & Associates can produce on providers’ behalf.