Medicaid Rate Reviews & Appeals

One of the most important documents you will receive all year is your New York State Medicaid Rate. As you know, it’s the basis for all the revenue you can expect from the government for your Medicaid patients. And it couldn’t be more complex – especially now.  

Don’t let New York State’s complicated Medicaid reimbursement methodology shortchange you and your patients.

It may be tempting to file it and forget it, but it’s critical that you undertake a rigorous review of the state’s determination of your reimbursement rates. Does it match the information in your cost report? Have they taken into consideration all of the factors that affect your operation? This is an opportunity to significantly improve your revenue for the year.

How complicated is it?

Extremely. New York State has just issued the first serious revision of its Medicaid reimbursement methodology since 1986. Since then, a great number of modifications and case law decisions have occurred, resulting in a patchwork of regulations that can stymie even the most experienced health care facility executive.

There’s the new 2002 rebasing methodology. There’s the RUGSIII modified pricing system. There’s MDS and Medicaid only case mix.There’s the Regional Input Price Adjustment Factor (RIPAF) still hanging on even though it has undergone several revisions since its inception. There’s therapy overhead, BMI, dementia and add-ons; adjustments, trend factors, limitations and more. The good news is, we can keep track of it so you don’t have to.

We check, and when warranted, we appeal

Our service to you begins with a rigorous review of your rate calculation, to be sure you’re receiving the full amount due to you. If not, we initiate an appeal. In many cases, we have gotten ahead of the work because we have prepared the underlying cost report for our clients.

Each year, we handle approximately 200 appeals on behalf of clients. While most appeals remain held up in the onerous NYS beauracracy, it is imperative that appeals be filed within the regulatory time periods to protect your rights. Don’t lose out on reimbursement you are entitled to because of a missed deadline or a belief in the futility of the system. The appeals will get answered – we can help shepard your appeals through the system.

We can help you, and we invite your inquiry.