F3’s Healthcare team combines the skills of industry specialists with those of investigative professionals, forensic accountants and compliance experts. Our team offers in-depth experience in addressing the transactional, legal, and regulatory challenges that confront healthcare companies. Moreover, our substantial experience handling such matters allows us to bring an informed but independent perspective to our clients.
F3’s services, such as compliance monitoring, forensic accounting and fraud examination can help healthcare providers to strengthen operations as well as protect assets and reputations. Our work is based on proven, efficient, and cost-effective approaches. Some of the Healthcare specific services we offer are:
- Medicare Disproportionate Share (DSH) Services
F3 professionals have been providing DSH services for more than 10 years. In just Arizona, F3 has identified more than $100 million in incremental DSH reimbursement for its hospital clients. F3 has served the majority of Arizona DSH hospitals and is not only respected by our clients, but also the Medicare auditors. In fact, a number of current and former Medicare auditors have served as client references on past proposals prepared by F3.
Over the past 10 years we have obtained a detailed understanding of the complex Medicare system, allowing us to develop a data-intensive DSH process we believe is second-to-none. Our well-tested process allows for great flexibility because it recognizes that not every hospital operates in the same fashion and can provide the same level of detail. Our process is designed to make the most out of all available data and to allow our clients to obtain the maximum reimbursement they are entitled to under Medicare regulations.
F3 is constantly evaluating our DSH services and has modified our process to respond to the ever-changing Medicare audit process. Our services can now provide initial reports for cost report filing purposes while ensuring patient retro-active eligibility is accounted for when the filed cost report is audited. Our process also seeks to recover funds from the respective Medicaid payers which provides additional value to our clients.
- Medical Education (IME/GME Reimbursement)
F3 professionals are also experienced in the areas of Graduate Medical Education (GME) and Indirect Medical Education (IME), collectively referred to as medical education. Our deep industry skill and prior auditor experience allows us to work with hospitals and their fiscal intermediaries to resolve of host of issues related to medical education reimbursement. From the revision of per resident amounts determined in the base year to modifying FTE counts based on rotation schedules, our services cover all aspects of Medicare medical education reimbursement.
The regulations related to medical education reimbursement are constantly changing and create opportunities for hospitals to lose substantial reimbursement if the regulations are not complied with. Many of the medical education changes require hospitals to make requests in advance of changing their programs structures and apply significant reductions in reimbursement if these requests are not made. Our services including working with hospitals to properly structure their medical education programs to ensure losses of reimbursement are not incurred.
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F3’s professionals have also been providing Medicare bad debt services for over 10 years. F3 believes an important factor in successful bad debt recovery is well functioning patient accounting and business office processes. F3 has a well-tested process that we modify as needed to meet the needs and business practices of our clients.
Documentation is critical in the process of being properly reimbursed by the Medicare Program for unpaid bad debts. Our services consist of working with hospitals to create an effective prospective process for identifying Medicare beneficiaries with unpaid deductibles and coinsurance. Once qualified bad debts are identified, our process focuses on consistent, well defined processes that seek to either recover the unpaid amounts or qualify them for reimbursement from the Medicare Program. Our past Medicare auditor experience and current relationships with many Fiscal Intermediaries (FIs) or Medicare Administrative Contractors (MACs) affords us the ability to work closely with the reviewing individuals to ensure Medicare bad debts are reimbursed appropriately.
In those instances where a prospective process does not address bad debts claimed in prior periods, our professionals work with hospitals to create bad debts logs which comply with current Medicare regulations. This process includes the identification of allowable accounts and review of those accounts to meet the financial, collection and documentation criteria for proper reimbursement from the Medicare Program.
During all of our engagements F3 works with the FIs and/or MACs during the audit to obtain final payment from the Medicare Program. Our work will include reviewing adjustment reports, auditor work papers, answering auditor questions and providing supporting documentation needed by the auditors during the audit. Our work typically concludes with the issuance of a final settlement by Medicare; however often times we will also handle any related reopening or appeals that may arise.
- Medicare Cost Report Preparation
F3 professionals have the knowledge and experience to prepare Medicare Cost Reports for our clients, ranging from stand alone hospitals, skilled nursing facilities, hospices and home health agencies to entire health networks. With professionals who were former Medicare auditors, we understand the entire cost reporting process from initial settlements to cost report acceptance and auditing. Our cost report preparation services include an extensive review of the providers’ financial records to ensure the cost reports are prepared in compliance with the current Medicare regulations using the current CMS approved cost reporting forms. Our working papers are prepared in a complete and comprehensive matter allowing the Medicare auditors to review and audit these reports without having to make extensive follow-up requests to the provider. F3’s cost report preparation services are provided to assume this time-consuming and complicated task, and to allow our clients to focus on their primary business or providing healthcare services.
- Medicare Cost Report Appeals Services
F3 also handles Medicare Cost Report Appeals for many of our clients. While some of these appeals relate directly to work under our other services, many of these appeals are for clients for whom we provide no other services or for matters not directly related to our work on other engagements. The Cost Report Appeals process is extremely lengthy and requires that many specific submissions be made within very strict deadlines. F3 can provide beginning-to-end service on these appeals, relieving our clients from having to prepare the numerous submittals and track and meet the appeal deadlines. Our Appeals services cover the entire appeals process including issue research, case presentation and resolution with the FIs and MACs in certain instances. Additionally, F3 professionals have a comprehensive understanding of the Board rules made effective in August 2008 and our work ensures strict compliance of the new rules with the ultimate objective of resolving the provider’s issues in the most efficient and cost effective manner.
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Other Healthcare Services:
- Damages calculations for disputes
- Expert witness testimony
- PRRB witness testimony
- Lost profit claims
- Feasibility studies and financial modeling
- Cost Report training and regulatory research
- Issue resolution and representation with Medicare contractors
- Wage index services
Representative Engagements:
- Provide consulting services related to medical education services including recalculating base year per resident amounts, establishing new programs, computing resident caps, determining resident FTE counts, and establishing temporary changes to resident caps through various provider agreements.
- Prepared a damage calculation related to a dispute between an managed care organization and a laboratory services provider.
- Prepared and filed numerous Medicare appeals and reopening requests including partial and full administrative resolutions for various appeal issues.
- Prepared financial models for feasibility studies related to hospital expansions, the development of new providers or services, and to comply with various state mandates regarding hospital construction.
- Analyzed contracts and computed reimbursement discrepancies related to case management services between a large healthcare organization and various state agencies.
- Analyzed large amounts of complex data to compute overpayments related to a large healthcare organization’s medical supply services.
- Computed damages related to a breach of contract dispute between a pharmaceutical company and a drug marketing organization.
- Analyzed payor data of a health care provider in comparison of the payments made by an insurance carrier.
- Review supply transactions to determine appropriateness for Medicare billing.
- Analyzed client billing and payment practices.
- Investigated the practices of benefits manager as it related to a contract to evaluate compliance.
- Performed a business review on behalf of a creditor organization to determine the financial health of a health system.
- Performed investigations of hospital Medicare bad debts.
- Performed financial audits for hospitals related to third part reimbursement and Medicare payments.
F3’s professionals have performed services for many different entities within the Healthcare industry, including:
- Hospitals and Health Systems
- Skilled Nursing Facilities
- Home Health Agencies
- Critical Access Hospitals
- Durable Medical Equipment (DME) Organizations
- Insurance Providers
- Physician Services
- Internet-based Physician Services
- Laboratory Services Providers
- Pharmacy Benefit Managers
- Pharmaceutical Companies
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