Healthcare Consulting

Regulatory Compliance & Reimbursement

Looking to achieve greater financial and operational excellence? Let us help you reach your goals today. 

Trusted & tailored healthcare regulatory compliance & reimbursement consulting solutions.

FORVIS has a dedicated team of reimbursement and regulatory professionals with a rich history of knowledge that spans from Medicare and Medicaid inception to current day, which extends beyond cost report preparation. We help provide in-depth, tailored solutions in many targeted areas, including cost report preparation and review, academic medical center programs, Worksheet S-10 uncompensated care costs (UCC), Medicare bad debt recovery and reporting, Medicare and Medicaid disproportionate share hospital (DSH) services, healthcare wage index reviews and reclassifications, time study, 340B Drug Pricing Program, and UPL supplemental payment programs.

Click below to read more about these regulatory compliance and reimbursement consulting services.

Cost Report Preparation & Review

If properly presented, the cost report has a direct impact on the Medicare and Medicaid reimbursement that organizations receive. That’s why it’s important to understand how you’re being paid compared to the cost of rendering services to Medicare and Medicaid patients.

As one of the country’s largest cost report preparers, more than 2,000 providers rely on FORVIS’ Medicare and Medicaid cost report expertise to help them increase reimbursement.

Cost Report Electronic Workpapers

Coming Soon: HFS+ streamlines cost report preparation to help deliver a concise work product and more effective review process. HFS+ was designed by healthcare finance professionals for healthcare finance professionals in coordination with Health Financial Systems (HFS), the industry’s largest provider of cost report software. In addition to cost report workpaper templates that are consistent with the latest version of HFS, users of HFS+ receive unique dashboards that can help focus cost report reviews and assist in identifying positive and negative trends impacting Medicare reimbursement.

FORVIS also offers an extensive suite of additional digital solutions to help meet our clients’ needs by using sophisticated technology and data analytics platforms, models, and databases.

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Co-Sourcing Services

As healthcare providers deal with an ever-growing demand for resources, the impact of the staffing skill set crisis, ongoing regulatory updates, and deadline reporting requirements can add to the daily challenges affecting your ability to make critical decisions. That’s why many healthcare providers turn to FORVIS for regulatory reporting and reimbursement support, including: 

  • In-depth reimbursement department services
  • Cost report assistance and training
  • Timely strategic evaluation of regulatory changes
  • Strategic reimbursement assessments
  • Education and training
  • And more
     

Medicare Bad Debt

FORVIS’ devoted Medicare bad debt team consists of a core group of technically equipped professionals. Our team assists with preparing Medicare bad debt logs, monitoring key relevant regulatory developments, and providing Medicare audit and appeal reopening assistance for clients across the continuum of healthcare. This level of specialization allows our team to help provide high-level service while utilizing next generation data analytic platforms that incorporate data from multiple sources combined with a proprietary process to complete the logs to assist with compliance as well as help improve reimbursement.

For more info on Worksheet S-10 UCC and DSH services, see the hospital and health system reimbursement services section below.

340B Drug Pricing Program

The 340B Program can bring significant savings and compliance risk to your hospital, health system, and/or community health center. It’s important to have a program that helps identify compliance issues and operates efficiently. That’s why we have team members who specialize in the 340B Program to help organizations assess compliance, reduce risk, and identify areas for operational improvements. Here’s how we can help:

  • 340B Program Development & Optimization
  • 340B Compliance
  • Pharmacy Expansion
  • Pharmacy Structure
  • Opioid Prescription Monitoring
  • Provider-Based Billing

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Provider-Based Reimbursement Services

FORVIS can assist providers in understanding the complex regulatory and reimbursement considerations related to provider-based status for physician practices, hospital outpatient departments, and rural health clinics. We can help with financial assessments, reimbursement implications, regulatory gap analysis, transition advisory services, and design and structure.  

Medical Residency Reimbursement Services

Our depth of knowledge regarding Medicare and Medicaid reimbursement regulations combined with our specific medical residency experience uniquely positions FORVIS to help our clients in this niche. We can assist your organization with:

  • Feasibility analyses
  • Education and training
  • Implementation of medical residency programs 

We use a phased approach, which can be tailored specifically to your needs, including preliminary assessment and road map, creation of financial analyses, identification of necessary business resources, and project management to help guide your organization through implementation. 
 

Hospital & Health System Reimbursement Services

In addition to the services listed above, FORVIS’ dedicated regulatory and reimbursement team has developed tailored solutions to assist your hospital or health system. Learn more about each of our targeted services below.

  • Time Study Solutions
  • Worksheet S-10 Uncompensated Care Reporting
  • Transfer DRG Identification
  • Medicare Wage Index Reviews & Reclassifications
  • Medicare & Medicaid DSH Testing 
  • Medical Education Reimbursement (IME/GME/Nursing Allied Health)

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Senior Living & Long-Term Care Reimbursement Services

FORVIS is one of the largest cost report providers nationwide and our insight into reimbursement issues equips us to help senior living and long-term care providers navigate Medicare and Medicaid regulations and reporting requirement changes, and we assist in analyzing reimbursements to compare payments with the cost of rendering services. 
In addition to the services listed above, we also can help with:

  • UPL Supplemental Payment Program
  • Medicaid Rate Analysis & Appeals
  • Medicare PDPM Rate Optimization
  • Managed Care Contract Analysis & Negotiation
  • Outcomes-Based/Quality Component Reimbursement

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Home Care & Hospice Reimbursement Services

For FORVIS home health and hospice clients, we help provide benchmarking analyses in addition to cost report preparation. This operations analysis is based on information in the Medicare cost report and compares your agency’s data to other home care and hospice agencies. See the list below of regulatory and reimbursement services specific to your home care or hospice organization. 

  • Medicare and Medicaid cost report preparation
  • Assistance with provider enrollment for startup or change of ownership

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Community Health Center Reimbursement Services

FORVIS prepares hundreds of CHC cost reports each year. We also assist many CHCs with their state Medicaid cost report filings. We’ve developed cost report forms for several states and are familiar with the scope-change process under the Medicaid prospective payment system (PPS) that many states use to update Medicaid PPS rates.
In addition to the services listed above, our third-party reimbursement solutions for CHCs and FQHCs include:

  • Medicaid PPS scope-change filing assistance
  • Medicare and/or Medicaid PPS planning and strategy assistance
  • Medicare Advantage assistance
  • Assistance with Medicare and/or Medicaid cost report settlement process and related desk audits or reviews

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