In the ever-changing world of regulatory reimbursement, it is more important than ever for hospitals and health systems to have robust reimbursement expertise. Regulatory professionals’ primary focus is on governmental funding regulations and the complexities in capturing a hospital’s opportunities for reimbursement.
It’s vital for your organization to have access to regulatory professionals who understand the complexities of Medicare and Medicaid reimbursement, whether through a dedicated internal department or by outsourcing the responsibilities. When considering this role, an important question comes to mind: How can your reimbursement professionals help your organization pursue growth?
One way to pursue growth is by having a pulse on the regulatory environment. This can have a significant effect on current and future reimbursement. Changes proposed by federal and state governments can affect your eligibility to participate in existing programs, change your reimbursement, or provide you with the opportunity to participate in new programs.
Regulatory changes over the past decade have solidified the important role of reimbursement professionals in hospital and health systems’ financial well-being.
In the future, as the industry continues to increase in complexity, regulatory reimbursement professionals will continue to play a critical role in helping organizations adapt to changes and capture funding intended for them. Some examples of these changes include:
- Federal agencies issue proposed and final rules in addition to various other communications throughout the year. Each of these brings changes that may affect your organization’s reimbursement. For those items that are unfavorable to the hospital or inconsistent with policy, your reimbursement professionals can help issue comments to the regulatory agency on your behalf.
- Federal agencies also evaluate the Medicare supplemental security income (SSI) ratio on an annual basis. It is important for someone to monitor your organization’s SSI ratio upon release as part of your qualification for Medicare disproportionate share hospital (DSH) payments and eligibility for participation in the 340B Drug Pricing Program.
- In addition to federal rules, each state has its own set of rules affecting reimbursement. Your reimbursement professionals can help you review these rules for opportunities including matching federal funding, Medicaid DSH payment opportunities, and capital cost reimbursement for new projects.
To learn how FORVIS can help you take your regulatory reimbursement department to the next level, visit our site to read more about our regulatory co-sourcing and outsourcing enterprise solutions.