Healthcare reform and regulations continue to bring dramatic change as costs increase and reimbursements decline. Yet expectations for patient care rise. Forward thinking organizations that face these pressures with an open-mind toward value-based models and new technology can improve profitability, efficiency, and the client experience. CohnReznick’s Healthcare Industry Practice responds with holistic solutions that are both strategic and pragmatic. This is especially true for Federally Qualified Health Centers (FQHCs) and community-based healthcare organizations.
AT THE INSTITUTIONAL LEVELHealth systems and hospitals of all sizes, both public and private, risk loss of revenue unless they put in place systematic processes to assess operational fitness, troubleshoot deficiencies, and transition seamlessly to new reimbursement methodologies. CohnReznick brings in the expertise needed to analyze the financial, regulatory, and technical activities of the organization across functions. Among many of the outcomes, we may identify areas of improvement, risks, and liabilities, structure training programs, and develop solutions to Medicare and Medicaid purchasing initiatives.
AT THE COMMUNITY LEVELCohnReznick is active in helping community health centers evaluate their performance and reimbursement and regulatory procedures in order to operate efficiently. Each organization needs to develop its own optimal response to healthcare reform and approach to federal grants management. Our work with organizations such as the National Association of Community Health Centers, National Council for Behavioral Health, state and regional primary care associations, and others keeps our team abreast of the industry-wide conversation as legislation evolves, and aware of the many innovative ways that challenges are being addressed.
REFORM EXPERTISEThe practice stays abreast of regulatory changes as they happen and can strategically advise on Accountable Care Organizations (ACOs), Patient-Centered Medical Homes (PCMH), Independent Practice Associations (IPAs), Medicare and Medicaid Value Based Payment (VBP), and other operating models.
Positioning healthcare organizations for success is critical during these changing times. Our team develops business plans and financial projections that are fully aligned with the organization’s strategic initiatives, putting into place financial management systems that can adapt to change under health reform.
MEDICAID AND MEDICARE RATE SETTING AND COST REPORTING
Our professionals assist with rate negotiations and regulatory reporting relative to the FQHC Medicare and Medicaid Prospective Payment Systems (PPS). This includes developing the initial PPS rate setting system including the Medicaid managed care supplemental payment program (“wraparound”).
REVENUE CYCLE AND VALUE-BASED PAYMENT READINESS
Given the complexities of today’s third party reimbursement protocols and system configurations, CohnReznick’s revenue cycle team works with healthcare providers in improving billing system efficiencies and collections. At the same time, members of our team are consulting with providers across the country on strategizing for participation in VBP. We’ve created a proprietary tool that identifies any gaps your organization has in requirements for transition to various VBP models, and prioritizes implementation.
IMPLEMENT FEDERAL COMPLIANCE PROGRAMS
We assess high risk areas and provide audit services and reporting as required for Section 330 of the Public Health Service (PHS) Act, Federal Financial Reports (FFR), and Federal Single Audit Requirements (Uniform Grant Guidance subpart F, formerly OMB Circular A-133). We also conduct annual independent audits and agreed-upon procedures for compliance with the federal 340B drug pricing program.