Hospital Reimbursement

Hospitals and other health care providers have come under increasing pressure from regulators and third-party payers to limit revenue growth and cut expenses. These revenue restrictions and cost-containment measures present a serious challenge to the financial performance of health care institutions.

Hospital’s financial managers, in particular, are caught between mandates to cap revenues and trim costs and the bottom-line imperative to see that the institution generates sufficient income to meet its operational goals. The burden of maximizing revenue from third-party reimbursements has increasingly been assigned to financial managers at the same time that hospital cost-containment policies may have required these departments to cut their own budgets. As a result, financial managers may well lack the staff, time and expertise with which to analyze and fully capitalize on all available reimbursement and other financial opportunities.

TriNet’s seasoned consultants offer extensive and valuable experience to assist hospital’s financial managers in performing this critical task. Among the services which TriNet has provided to financial management personnel:

  • Preparing and reviewing annual cost and budget filings to meet federal and state requirements.
  • Developing and implementing financial studies to maximize reimbursements.
  • Presenting provider positions to fiscal intermediaries.
  • Representing clients at provider appeal hearings.

For rate-setting review hearings, TriNet can prepare written justification for a provider’s cost report submission or exception request, taking into consideration the institution’s financial requirements, volume changes, case mix changes, and competitive environment. As part of the financial service offered by TriNet, the provider will receive:

  • Recommendations for enhancing reimbursements in future time periods.
  • An independent review of filed cost reports
  • In-service educational sessions for the hospital management team outlining the reimbursement implications of their action plans.