Disproportionate Share (DSH) Services
- Retrospective Qualification to ensure proper distribution.
- Expert consulting to assure regulatory compliance and reporting accuracy.
Human Arc’s Disproportionate Share Services offer significant added value in three different, customer-selectable forms.
Eligibility Qualification and Documentation
Some hospitals do not comprehensively screen and qualify uninsured patients for potential eligibility for “safety net” disproportionate share (DSH) funding status. In others, the qualification is focused only on a portion of potentially eligible patients (for example versus outpatient populations). Hence, uninsured patients who do not qualify for Medicaid coverage pass through the hospitals revenue cycle and into bad debt. Lack of attention to the opportunities can cost needless millions of dollars in lost reimbursement.
Partnering with Human Arc can be absolutely invaluable in order to optimize cash flow and improve program compliance. Our work ensures that our client hospitals receive the appropriate amount of funding available to them through the state disproportionate share pool and that they do so with optimum compliance to DSH program requirements. Human Arc’s experts systematically process self-pay or bad debt claims, with relevant service dates, which have either:
- Not been processed already for DSH funding eligibility or…
- Not been processed completely or correctly.
We identify and fully document all claims into categories established by state codes and requirements in order to establish disproportionate share funding eligibility. Human Arc assures that its efforts will integrate with clients’ internal and external collection processing and the requirements of the state’s Medicaid Cost Report.
DSH Process Consulting
Regulations governing operation of, and reporting for, disproportionate share programs are often complex and changing. It is hard for hospital management to keep up with the requirements and get all their relevant departments working together and observing the rules consistently. And, since most hospital processes
for disproportionate share qualification are manual, many hospitals face compliance risk in the internal administration of these programs.
Human Arc’s process consulting expertise can provide valuable help in this area. Our work helps ensure that disproportionate share funding policies and procedures employed by hospitals are in strict compliance with relevant government regulations and result in an accurate financial outcome for the medical provider.
Cost Report Review
Because Medicare and Medicaid Cost Reports are the result of a long, aggregate process across departments, innumerable individuals and, in many cases, multiple facilities and reporting styles, component data can easily be inconsistent, inaccurate, missing or duplicated. Since inaccurate reporting drives inaccurate reimbursement (and potential penalties), efforts should be made to mitigate compliance risks. And given that the Medicare report is the source document for the Medicaid report, it is imperative that both pieces are analyzed together.
Human Arc’s cost report review process conducts a thorough review of key data elements within both the client’s Medicare and Medicaid Cost Reports. In these reviews, specific emphasis is placed on open cost reports in areas most significantly influencing future disproportionate share distributions. Opportunities with potential reimbursement implication are then submitted for the consideration of hospitals’ financial and reimbursement management.
The Human Arc Edge in DSH Initiatives
With Human Arc, our clients enjoy many advantages:
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Experience – Human Arc has an unmatched track record with disproportionate share funding assistance to healthcare providers.
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Focus – Government healthcare program eligibility is our core focus.. We take our success in this respect as our mission statement.
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Compassionate human orientation – We have decades of experience interviewing and helping the uninsured and underinsured. We conduct tens of thousands of interviews each year.
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Hospital-Level Knowledge – We analyze many hospitals’ policies, procedures and practices, so we quickly get to the "heart of the matter.”
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Data Management and Analysis Skills – We have unmatched expertise working with various platforms, technologies and types of data, as well as analyzing trends and statistics to identify issues and opportunities.
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Comprehensiveness – Human Arc understands that a successful disproportionate share services program may also require a variety of additional assets and capabilities:
- Extensive experience analyzing and improving internal processes.
- Expertise in screening, qualifying and documenting patients for DSH programs.
- Flexible data management tools to assist or supplement client capabilities.
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Security – Human Arc is 100% HIPAA-compliant. Clients can be assured that their patients’ privacy and information confidentiality are fully protected.
Case Studies
Nothing speaks like proof, so here’s how our service has actually helped its clients.
Disproportionate Share Presentations
Note: Healthcare providers in Ohio may wish to link here to
www.ehcap.com. eHCAP is a Human Arc-maintained information source on Ohio's Hospital Care Assurance Program. eHCAP links to the appropriate Ohio Administrative Code segment, federal poverty guidelines, ODJFS prospective data review findings, HCAP distributions by hospital, plus other information that answers questions about Ohio's disproportionate share program.