From the very beginning, we have focused on helping our clients turn data into meaningful and actionable solutions. We really enjoy finding the needle in the haystack, and frankly we are pretty good at it. Working with hundreds of hospitals over the past 13 years, we have created processes that deliver results and help hospitals achieve their objectives.
Our team approach ensures that you have access to the staff members who can best address your needs. Account Managers, Data Analysts, Consultants, and Support staffs are all committed to finding the solutions to your issues. We encourage open and frequent dialogue throughout the process to make certain we customize our approach based on your objectives.
Cost Containment Strategies
Monitoring and managing costs is a never-ending battle for most hospital financial teams. Cleverley + Associates is uniquely positioned to provide your hospital with accurate recommendations that will help enhance its overall profitability. Our goal is to provide complete satisfaction and absolute value in each of our strategic partnerships. From small rural facilities to large teaching hospitals and health systems, we customize our approach to meet your needs.
Our approach is to evaluate cost from macro and micro levels of analysis. Utilizing our extensive database of public and proprietary information, we provide an assessment of relative cost position, as well as relevant opportunity areas for cost containment. These areas of opportunity present management with the ability to make well-informed decisions in specific areas that will yield positive financial results.
What sets us apart from other vendors?
- A thorough review of your hospital’s current cost position
- Ongoing dialogue with your management team about your objectives, assumptions, and concerns throughout the project
- WebEx presentation by a Cleverley + Associates consultant
- A complete suite of supporting reports and detailed comparative data by facility, department, and encounter
- Flat fee consulting engagement
To learn more about our theories and methodology, visit our published articles page and download a white paper or watch one of our webinars on cost benchmarking.
For a custom analysis of your hospital’s current cost position submit the Let’s Talk form below. We will run a FREE comparative report with cost data from your hospital and other hospitals in your market. We will then contact you to schedule a 30-minute call to discuss our findings and you get to keep the report. No charge, no strings attached.
Coding and Billing Reviews
Coding and billing accuracy is key to a hospital’s financial performance. Issues in these areas can lead to potential missed reimbursement opportunities or serious compliance problems. Our staff of experienced coding and billing specialists can review your inpatient and outpatient claims to make sure that your hospital is being properly reimbursed and not in jeopardy of compliance-related issues.
We provide an analysis of inpatient coding and billing to identify coding trends and uncover potential reasons for decreased payment. The foundation of the analysis is identifying coding and documentation opportunities that may impact case mix index performance under MS-DRGs. The analysis provides CC/MCC capture rate and CMI variances among the facilities reviewed.
The analysis details:
- CC/MCC Capture Rate and CMI for all MS-DRG families
- Detailed peer comparisons by MS-DRG family
- Coding Patterns
We evaluate up to 30 categories of potential outpatient missed reimbursement in categories such as:
- Surgical procedures
- Lab procedures
- Pharmacy & device items
- E/M Levels
We will also provide measurements of data quality based on Outpatient Code Editor (OCE) errors and a profile of drug and biological billing and coding practices.
To learn more about our methodology, visit our published articles page and download a white paper or watch one of our webinars on coding & billing.
For a custom review submit the Let’s Talk form below. We will run a FREE comparative report with cost data from your hospital and other hospitals in your market. We will then contact you to schedule a 30-minute call to discuss our findings and you get to keep the report. No charge, no strings attached.
Revenue Enhancement Opportunities
SSI Shift Analysis
A shift of your hospital’s SSI percentage from the Federal fiscal year to your hospital fiscal year could result in increased Medicare DSH payments. Cleverley + Associates will work with the Centers for Medicare & Medicaid Services (CMS) as your agent to obtain the detail data necessary to recalculate the SSI percentage on your hospital fiscal year and validating that the resulting shift is indeed beneficial. We will then assist you in requesting this change, which may include a reopening request, to the cost report through your Medicare Administrative Contractor (MAC).
When your SSI percentage is trending up, your hospital can shift to your hospital fiscal year and receive increased Medicare DSH payments. We will use the data from CMS to recalculate the SSI based upon your hospital fiscal year to insure that the change will be beneficial to your hospital before any formal request to use your hospital fiscal year is made. Once a formal request is made, the hospital must use the revised SSI so it is imperative that the opportunity be confirmed prior to making the election.
Post-Acute Care Transfer Audit
If your hospital does not have a system in place to audit Medicare payment for post-acute transfers, you may be leaving a substantial amount of money on the table!
When the CMS modified its transfer payment policy, the goal was to eliminate “double payments” for patients that were admitted to acute care hospitals but transferred to post-acute care facilities. Transfer DRGs were created and hospital payments were reduced; unfortunately, the resulting system of checks and balances put in place by CMS does not fully protect the interests of both CMS and hospitals.
If a transfer DRG was assigned but the care was not provided (or not provided in the proper time period) hospitals may recoup the underpayment.
Cleverley + Associates will review your post-acute transfer claims and validate the actual delivery of post-acute services where indicated on the claim. We will identify any Medicare claims where original payment was reduced because of a transfer discharge status and there is no Medicare payment for the delivery of post-acute transfer services. By resubmitting these claims, your hospital can recoup significant payments.
One of our greatest strengths is our ability to customize projects to meet our clients’ exact needs and specifications. We don’t force you into one of our boxes; we build you a custom box. We have the data and expertise to investigate a wide range of issues related to hospital finance. If you have a question, call us.