Medicare and Medicaid Reimbursement

Interpreting and understanding Medicare and Medicaid regulations can be confusing. Make sure your facility measures up with knowledgeable advice to address your complicated coding, compliance and revenue issues. Provider Consulting Solutions' reimbursement analysis and support services are designed to protect and enhance your bottom line by recovering full payment through the following, including but not limited to:

Reimbursement Analysis/ Rate Review

We offer Impact Analysis of healthcare reform and changes to methodology and/or payment rates. PCS will work with your facility to quantify and prioritize associated operational and financial risk while developing strategies to maximize hospital operations within the reformed environment.

Regulatory Support

Healthcare providers operate in a complex financial environment. They must be fluent in multiple coding methodologies (ICD-9-CM, HCPCS, CPT-4) and comply with different and sometimes conflicting third party payer regulations...all of which is constantly changing. Making sense of it all is easier with PCS on your side.

Provider Consulting Solutions' experienced consultants can help you interpret and understand Medicare and Medicaid regulations, and offer knowledgeable advice to address your complicated coding and billing issues.

PCS' Coding and Regulatory Support services include:

Email and telephone access to a diverse team of professional healthcare consultants - ask us a question and we'll find the answer. Call us today! Ad hoc payment verifications and claim denial investigations - have a claim that was denied or paid incorrectly? We'll help you figure out why. As needed coding advice - send us that complicated procedure report and our certified coders will guide you to the most appropriate code(s). Submission of inquiries on the provider's behalf to payers and/or coding agencies. Representation at billing appeals with the Fiscal Intermediary or Carrier.

Disproportionate Share (DSH)

We offer our cost report preparation and pre-audit services to both public and private acute care and rehabilitation hospitals to maximize Federal and State Disproportionate Share (DSH) revenue .