acumen Critical Access Hospital Medicare€¦ · Agenda Reimbursement Update Current Status for Critical Access Hospitals (CAH) Medicare Inpatient PPS Final Rule - FFY 2018 Final

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Critical Access Hospital Medicare

Reimbursement Update and

Financial Improvement Tools

Presented by

Ann King White, CPA

& Tammy Rivera, CPA

BKD, LLP

January 16, 2018

Western Symposium – Region 10 & 11

Agenda▪ Reimbursement Update

❖ Current Status for Critical Access Hospitals (CAH)

❖ Medicare Inpatient PPS Final Rule - FFY 2018

❖ Final Rule CY 2018 for OPPS and Other Providers

▪ Preparing for the Future

❖ CAH Metrics and Financial Measures

1. Profitability

2. Revenue

3. Liquidity

4. Capital Structure

5. Operational Measures

Conference Hospital Analysis ▪ Analysis of Western CAHs including Hospital’s attending the

conference with CHA Comparative for 13 Western States:

✓ Medicare cost reports from FYE 2016, obtained on-line

❖ Western CAH Hospital census = 285

✓ Alaska (AK) =14

✓ Arizona (AZ) = 14

✓ California (CA) = 34

✓ Colorado (CO) = 29

✓ Hawaii (HI) = 8

✓ Idaho (ID) = 27

✓ Montana (MT) = 47

✓ New Mexico (NM) = 9

✓ Nevada (NV) = 12

✓ Oregon (OR) = 25

✓ Utah (UT) = 11

✓ Washington (WA) = 39

✓ Wyoming (WY) = 16

Conference Hospital Analysis

▪ Western CAH Average Bed Size = 20

❖ Individual State Averages:

✓ Alaska = 16

✓ Arizona = 21

✓ California = 20

✓ Colorado = 19

✓ Hawaii = 10

✓ Idaho = 19

✓ Montana = 20

✓ New Mexico = 24

✓ Nevada = 17

✓ Oregon = 22

✓ Utah = 20

✓ Washington = 22

✓ Wyoming = 20

Reimbursement Update

Inpatient PPS (IPPS)

FFY 2018 Final Rule

Reimbursement Current Status

for CAHs Hospitals

▪ CAH hospitals on holding pattern, same as PY

▪ Sequestration at 2% cut all Health Care

▪ Cost Reimbursement still at 101% less 2% = 99%

❖ But this is an area that has brought discussion

to reduce by 1%

✓ So From 101% reimbursement to 100%, then with 2%

sequestration would mean reimbursement at 98%

• Last year CMS selected CAHs to participate in the Frontier Rural Community Health Integration Project Demonstration (FCHIP)

▪ Developed to test new models for the delivery of health care services, improve access, and better integrate delivery of acute care to Medicare beneficiaries

▪ Period of performance August 1, 2016 – July 31, 2019

▪ Goal is to maintain budget neutrality for the demonstration project

▪ Any increase in Medicare payments will be recouped from allCAHs through a reduction in Medicare payments over a three year period of cost reporting years, beginning in calendar year 2020. So CMS notes there is no impact on FY 2018.

CAH HOSPITALS IN FCHIP DEMO

PROJECT

• CMS to direct QIOs, MACs, SMRCs and RACs

to make the 96-hour cert. a low priority for

medical records reviews.

▪ Effective for review conducted after 10/1/2017

▪ Covers the rule where a physician certifies patient

can be discharge/transferred in 96-hours

• Unless there is probably fraud, waste or abuse

• Other reviews, such as by OIG, DOJ or ZPICs

are not effected

REVIEW OF CAH 96-HOUR

CERTIFICATION REQUIREMENT

PPS Hospital Rates FFY 2018

Impact for Quality Reporting and MU

9

FFY 2018

Submit

Quality

Data &

meets MU

Submit Quality

Data & does

not meet MU

Did not submit

Quality Data &

meets MU

Did not submit

Quality Data &

does not meet

MU

Market basket update 2.70% 2.70% 2.70% 2.70%

Productivity Cut - ACA -0.60% -0.60% -0.60% -0.60%

Add Cut ACA (1886) -0.75% -0.75% -0.75% -0.75%

Two-midnight policy Adj -0.60% -0.60% -0.60% -0.60%

Documentation &

Coding Cut restoration

+0.45% +0.45% +0.45% +0.45%

Total Increase PPS Rate 1.20% 1.20% 1.20% 1.20%

Adjustment if no quality

data submitted

-0.70% -0.70%

Adjustment if not

meaningful user

-2.00% -2.00%

Net change to

standardized amount

1.20% -0.80% 0.50% -1.50%

Rebasing and Revising the Hospital Market Basket Cost weights

▪ “Rebasing” means moving the base year for the structure of the cost of an input price index.

▪ “2014-based” (i.e. cost reporting periods beginning 10/1/2013-9/30/2014) data proposed as the base period for the construction of the market basket cost weights, previously the base was “FY 2010-based” which follows the established rebasing frequency of every 4 years.

▪ “Revising” means changing the data sources or price proxies used in the input price index.

▪ WHAT ABOUT Medicare Rebasing SCH Base Year Rates? Important Discussion and Considerations

FINAL REBASING & REVISING OF THE HOSPITAL

MARKET BASKETS FOR ACUTE CARE HOSPITALS

Wage Index Issues▪ Does not Apply to CAH’s

▪ No Proposed changed to the Frontier Policy

❖ Frontier states (Montana, North Dakota, South Dakota, Wyoming &

Nevada) guaranteed 1.0 WI

▪ National average hourly wage

❖ $42.0564 in 2018 or Annual 2080 hours = $87,477

❖ Prior year final was $41.07 or 2.4% increase or $85,426

▪ Methodology

❖ If a hospital terminated data remains in the WI unless not reasonable

❖ If a hospital has become a CAH before 1/23/17, data excluded

▪ Reclassification

❖ Currently 906 hospitals are reclassified

❖ For FFY 2019 must apply by 9/1/17

11

• Uncompensated Care – FY 2018 and after

▪ Does not apply to CAHs but CAHs do complete the cost report schedule – Western CAH Average for:

• Uncompensated Costs = $1.9M

• Bad Debt Uncompensated Costs = $0.8M

• Total Uncompensated Costs = $2.7M

▪ To begin using S-10 data for allocation of uncompensated care beginning in FY 2018

• To be consistent with FY 2017 proposed changes, use 3 years of cost report data for S-10 allocation

▪ Medicaid days from FY 2012 and FY 2013 cost reports

▪ FY 2014 and FY 2015 published SSI ratios.

▪ FY 2014 S-10 uncompensated care data

DSH & UNCOMPENSATED CARE

▪ Cost Reimbursement for Inpatient Services only for Hospitals under 50 beds.

▪ Maximum of 30 participating hospitals. (Prior participants can extend)

▪ Selection made and notified Sept 2017 for FYE starting after October 1, 2017

▪ Any rural community hospital in any State could submit an application. But, priority

granted to hospitals in the 20 states with the lowest population densities.

▪ Alaska, Arizona, Arkansas, Colorado, Idaho, Kansas, Maine, Mississippi, Montana,

Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Utah,

Vermont, and Wyoming

▪ Western State Hospitals in the Rural Demo:

▪ Alaska = 2, Colorado = 5, New Mexico = 1 and Wyoming =1

▪ Other states include: IA, KS, ME, MS, NE, OK, SD

RURAL DEMONSTRATION PROJECT

• Hospitals must submit request to MAC by

▪ September 1, 2017

▪ Criteria for FFY 2018:

• No longer based on ACA criteria – Less than 1,600 MEDICARE Discharges

• Reverts back to FY 2005 criteria – Less than 200 TOTAL Discharges

▪ But Pressure to make an LVA Fix from the IPPS Rule through an Extender Bill but uncertain

▪ Other Requirements:

• Mileage – more than 25 miles from nearest “like” hospital

• Discharges – based on total discharges less than 200 and is no longer payor specific

• Discharges based on most recent submitted cost report rather than MedPar data due to change to total discharges

LOW VOLUME ADJUSTMENT

▪ Electronic Signature and Submission:

• Under final rule the provider will be able sign the certification page of their cost report via electronic signature or original signature (as previously completed)

• A checkbox will be added to indicate if signing electronically on the settlement page

• If signed electronically, the provider can submit the Certification and Settlement Summary page in the same manner the MCR cost report is submitted (electronically versus hard copy and with the cost report)

• Certification must be signed by the “Provider’s Administrator or Chief Financial Officer”

• Effective for cost reporting periods that end on/after 12/31/2017

MEDICARE COST REPORTING AND

PROVIDER REQUIREMENTS

▪ Clarification of Limitations on the Valuation of

Depreciable Assets disposed of on or after

12/1/1997

• Final Rule clarifies that Medicare does not

recognize a provider’s gain or loss on the sale or

scrapping of an asset that occurs on or after

December 1, 1997, regardless of whether the

asset is sold incident to a provider’s change of

ownership or is otherwise sold or scrapped as an

asset of the Medicare participating provider.

MEDICARE COST REPORTING AND

PROVIDER REQUIREMENTS

Acute Care Volume Indicators▪ Western Analysis of CAH: Acute Care

❖ CAH Average Acute Days

– Medicare Acute Days = 676 (54%)

– Medicaid Acute Days = 160 (12%) ---- Both 66%

– Total Acute Days = 1,352

Acute Care Average Days by State

* Medicaid Expansion States

State MC

Days

MC

%

MCD

Days

MCD

%

Total

Days

Total % MC

& MCD

Alaska * 417 41% 207 21% 1,007 62%

Arizona * 563 39% 323 23% 1,432 62%

California * 977 53% 150 8% 1,847 61%

Colorado * 515 52% 163 16% 992 68%

Hawaii * 55 27% 63 21% 305 48%

Idaho 666 51% 161 12% 1,304 63%

Montana * 465 52% 129 14% 895 66%

New Mexico * 685 42% 175 11% 1,650 53%

Nevada * 841 53% 234 15% 1,573 68%

Oregon * 993 48% 154 7% 2,083 55%

Utah 499 48% 148 14% 1,038 62%

Washington * 844 52% 147 9% 1,621 61%

Wyoming 694 57% 105 9% 1,221 66%

Acute Care Reimbursement▪ Western Analysis of CAH: Acute Care

❖ CAH Acute Reimbursement (at Median)

– M/C Acute = $2,336 (45%)

– M/C Ancillary = $2,892 (55%)

– Total Reimbursement = $5,228

Medicare Acute Care Reimbursement per Day

State MC Acute MC Ancillary Total MC

Reimbursement

Alaska $3,252 $1,544 $4,796

Arizona $1,467 $2,211 $3,678

California $2,150 $4,918 $7,068

Colorado $2,761 $3,018 $5,779

Hawaii $3,105 $1,221 $4,326

Idaho $1,969 $3,045 $5,014

Montana $1,904 $1,564 $3,468

New Mexico $1,774 $3,981 $5,755

Nevada $1,901 $3,211 $5,112

Oregon $2,272 $3,071 $5,343

Utah $2,318 $2,463 $4,781

Washington $2,869 $3,151 $6,020

Wyoming $2,023 $3,138 $5,161

Swing Bed Comparison❖ CAH -- What is your utilization?

✓ SWB M/C Days range from 1 to 4,807– 36 CAHs had Zero

– Western CAH’s Average = 459

✓ M/C Utilization 32% to 100%

❖ Does it help your bottom line?

❖ What are the threats to this good reimbursement?

✓ What are opportunities to collaborate related to CJR

Comprehensive Care for Joint Replacement and other

upcoming payment bundles?

✓ OIG Report March 2015 “Medicare Could Have Saves

Billions…”

✓ Potential Cost Savings for “Medicare Extender Bills”?

Reimbursement

Regulations

CY 2017 Final Rule for Outpatient

OPPS and Other Providers

FY 2018 OPPS Final Rule

▪ Conversion factor update of 1.35% after

productivity and other adjustments

❖ CY13: $71.131 (1.59% increase)

❖ CY14: $72.672 (2.17% increase)

❖ CY15: $74.173 (2% increase)

❖ CY16: $75.582 (1.9% increase)

❖ CY 17: $76.829 (1.65% increase)

❖ CY 18: $78.636 (1.35% increase)

Outpatient Indicators &

Reimbursement

▪ Outpatient Ratios for Western CAHs

❖ Outpatient M/C Cost to Charge Ratios - Overall

✓ CAH – Range 14% to 223% -- Average 55%

❖ Outpatient Medicare Revenue per Calendar Day

✓ CAH - $18 to $174,672 – Average $28,713

❖ Outpatient Medicare Cost to Allowable Cost

✓ CAH - 16%

Medicare Outpatient Indicators

State OPT MC

Cost/Charge %

OPT MC Revenue

Per Calendar Day

OPT MC Cost to

Allowable Costs

Alaska 80% $11,324 9%

Arizona 35% $24,082 14%

California 40% $50,919 16%

Colorado 56% $27,210 19%

Hawaii 72% $2,991 5%

Idaho 57% $22,870 19%

Montana 67% $12,401 13%

New Mexico 43% $39,218 17%

Nevada 40% $42,527 18%

Oregon 52% $48,057 20%

Utah 56% $11,589 15%

Washington 54% $35,800 18%

Wyoming 61% $22,160 18%

RHC Rates -- CY 2018▪ Upper Payment Limit per visit (Does not apply to CAHs)

❖ Increase, rates in:

✓ 2016 = $81.32

✓ 2017 = $82.30

✓ 2018 = $83.45

▪ Reflects a 1.4% payment increase

▪ Western CAHs with RHCs (Limit does not apply)

❖ Average Per Visit cost CHA = $218 (over limit get + $136 ☺)

▪ IMPORTANT Billing Changes and Reimbursement Opportunities for

RHCs and Rural Providers including Chronic Care Management (CCM)

and Advanced Care Planning (ACP)

Rate Changes for Other Providers

2018

▪ SNF - Overall rate increase = 1.0%

▪ HHA – Overall rate decrease = (0.4%)

▪ Hospice – Overall rate increase = 1.0%

Preparing for the Future

CAH Metrics and Financial Measures

Financial Indicators and

Comparison Benchmarks

1. Profitability

2. Revenue

3. Liquidity

4. Capital Structure

5. Operational Measures

Profitability

Profitability

Goals for Profitability

Hospitals need to look for ways to be

❖ More Efficient

❖ Cost Effective

In the delivery of Services

Keep in mind the Triple Aim:

❖ Increase efficiency in providing care

❖ Improve the patient experience

❖ Improve outcomes

Western CAH Profitability

▪ Cost Report data FYE’s in 2016

❖ Net Operating Income -Net Patient Revenue less Expenses

CAH’s

✓ 81 out of 285 CAHs or 28% had Net Operating Income –

Average Net Income $3 Million

✓ 204 CAHs or 72% had Net Operating Losses --

Average Loss ($2.3 Million)

Western CAH Profitability

▪ Cost Report data FYE’s in 2016

❖ Net Income – Including Other Income

CAH’s

✓ 193 out of 285 CAHs were Profitable or 68%

✓ 92 CAHs or 32% had Net Losses --

Average Loss ($1.2 Million)

Total Margin % -- Western CAH Average

Compared to S&P Small Hospitals

-

1

2

3

4

5

6

7

8

9

10

Western CAH

Average

S&P A S&P BBB

5 5

2

Total Margin % By State

(2)

-

2

4

6

8

10

12

14

AK AZ CA CO HI ID MT NM NV OR UT WAWY

11

7

4

9

1 1

5

8

54

0

3

Total Margin %

Region 10

-2

0

2

4

6

8

10

12

14

AVE AZ CO ID MT NM UT WY

5

11

4

1 1

54

3

Total Margin % By State

(2)

-

2

4

6

8

10

12

14

AVE AK CA HI NV OR WA

5

-2

7

98

5

0

EBIDA Margin % -- Western CAH Average

Compared to S&P Small Hospitals

-

5

10

15

Western CAH

Average

S&P A S&P BBB

11 12

9

EBIDA Margin % By State

-

5

10

15

20

AK AZ CA CO HI ID MT NM NV OR UT WAWY

2

14

11

14 15

6 7

11

15

10

87

3

EBIDA Margin %

Region 10

-

5

10

15

20


11

14 14

6 7

11

8

10

EBIDA Margin %

Region 11

-

5

10

15

20


11

2

11

15 15

10

3

3

Revenue

Acute Medicare Utilization By State

-

20

40

60

80

100

AVE AK AZ CA CO HI ID MT NM NV OR UT WA WY

54

44 38

55 55

29

57 61

44

56 51

48

5863

Acute Medicare Utilization

Region 10

-

20

40

60

80

100


54

38

55 57 61

44 48

63

Acute Medicare Utilization

Region 11

-

20

40

60

80

100


54

44

55

29

56 51

58

Acute Medicaid Utilization By State

-

20

40

60

80

100


12 21

23

8 16

21

12 14 11

15

7 14

9 9

Acute Medicaid Utilization

Region 10

-

20

40

60

80

100


12

23 16 12 14

11 14 9

Acute Medicaid Utilization

Region 11

-

20

40

60

80

100


12 21

8

21

15

7 9

Outpatient Revenue to Total

-

20

40

60

80

100


70

65

83

68 78

45

73 66

77 74

78 71

74

51


Region 10

-

20

40

60

80

100


70

83 78

73

66

77 71

51


Region 11

-

20

40

60

80

100


70

65 68

45

74 78

74

Outpatient Medicare Utilization

-

10

20

30

40

50


30

21 23

32 30

14

32 29 28

33 32

27

31

39


Region 10

-

10

20

30

40

50


30

23

30 32

29 28 27

39


Region 11

-

10

20

30

40

50


30

21

32

14

33 32 31

57

Take a closer look at

Medicare Payments

▪ Re-examine that all

Medicare payments

are correct

▪ Verify the relationship

between coding and

payments

How Do Your Third Party

Payers pay... ▪ Depends on the payer and services

provided to the patient

❖ Fee for service

❖ Fixed payments

❖ Payments based on Medicare

methodology

❖ Contracts with payer

▪ AUDIT these payments

Acute Other Utilization By State

Who are your other patients?

-

20

40

60

80

100


34 38 38 39

32

52

37 34

47

32

45 38 39

34

Acute Other Utilization Region 10


-

20

40

60

80

100


34 38 32

37 34

47

38 34

Acute Other Utilization Region 11


-

20

40

60

80

100


34 38 39

52

32

45 39

Outpatient Other Utilization

-

10

20

30

40

50

60

70

80

90

100


70 79 77

68 70

86

68 71 72

67 68 73

69

61


Region 10

-

10

20

30

40

50

60

70

80

90

100


70 77

70 68 71 72 73

61


Region 11

-

10

20

30

40

50

60

70

80

90

100


70 79

68

86

67 68 69

Who are the Local Employers▪ Erica’s Story, HR Director at a Denver Corporate Office

❖ Company in 3 rural locations

❖ Local employees total – 800, 75, 60

✓ What if family size is an average of 3 = 2,400, 225, 180

❖ Industry under a bust 3 years ago, now getting better

❖ Had to cut costs to survive and looked at Healthcare

❖ Needed local Hospitals to partner with them

▪ Chose to direct patient’s elsewhere

❖ Making the Local Hospital out of network

▪ BE PROACTIVE.

▪ Find Solutions to keep patients LOCAL

Improve Revenue Realization▪ Analyze charge payer %’s by procedure

▪ Restructure charges to take advantage of

procedures with higher % of charge payers

▪ OR consider reducing charges to capture market

share for competitive pricing and consumer

shopping

▪ Update the hospital’s Charge Description Master

(CDM)

Medicare Bad Debts - CAHs▪ All Medicare Bad Debts are reimbursed at 65%

▪ Western CAH’s Average for Inpatient

❖ Deductibles & Co-Insurance Average = $208,860

❖ Average Bad Debts $18,834 or 9%

▪ Western CAH’s Average for Outpatient

❖ Deductibles & Co-Insurance $1,847,985

❖ Average Bad Debts $136,166 or 7%

Hospitals with No M/C Bad Debts- 65 out of 285 CAH’s or 23%

CAH

Bad Debts

23%

16%

11%14%

19%

17%

No Bad Debts

Under $25,000

Under $50,000

Under $100,000

Under $250,000

Over $250,000

Medicare Bad Debts

Bad Debts to Deductibles & Co-Insurance is 8%

Medicare Bad Debt Averages

State CAH Average

Claimed

State All Hospitals

Claimed

Alaska 4% 4%

Arizona 5% 6%

California 15% 19%

Colorado 3% 9%

Hawaii 2% 5%

Idaho 6% 3%

Montana 3% 2%

New Mexico 6% 6%

Nevada 14% 17%

Oregon 6% 10%

Utah 3% 5%

Washington 6% 11%

Wyoming 2% 2%

Liquidity

Cash is still King

Western CAH Liquidity❖ Current Ratio

✓ CAH Average 3.88 (State Range 2.41 to 6.92)

❖ Days Cash & Investments on Hand range

✓ CAH Average 106 Days (State Range 64 to 182)

❖ Net Days in Accounts Receivable

✓ CAH Average 54 Days (State Range 37 to 65 Days)

Current Ratio

-

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0


3.9 4.5 4.6

2.9 3.7

2.4

4.5

3.6

6.3

5.2

3.6

6.9

3.4 3.7

Current Ratio

Region 10

-

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0


3.9 4.6

3.7

4.5

3.6

6.3 6.9

3.7

Current Ratio

Region 11

-

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0


3.9 4.5

2.9 2.4

5.2

3.6 3.4

Days Cash on Hand

Including Investments

0

50

100

150

200

250

300

Western CAH A Rated BBB Rated

106

251

167

Days Cash & Investments

-

25

50

75

100

125

150

175

200


106

80 64

103

139

87 90

107

142 156

89

182

104114


Region 10

-

25

50

75

100

125

150

175

200


106

64

139

90 107

142

182

114


Region 11

-

25

50

75

100

125

150

175


106

80

103

87

156

89

104

Net Days in Accounts

Receivable

0

10

20

30

40

50

60

Western CAH A Rated BBB Rated

54

4744

Net Days In Accounts Receivable

-

25

50

75


54

47 49

52 56

40

51

65

37

62

46

55 5358


Region 10

-

25

50

75


54

49

56 51

65

37

55 58


Region 11

-

25

50

75


54

47

52

40

62

46

53

Capital Structure

Debt to Capitalization (%)

0

10

20

30

40

50

60

Western CAH A BBB

34

27

38

Debt Financing ▪ A word of caution

❖ Typical financing structures (i.e. long-term

revenue bonds) for major facility

improvements can generate strong cash flow

in early years but could have insufficient cash

flow to make the payments in later years

❖ CHA cost reimbursement higher in early

years from Depreciation and Interest

❖ Important to understand your forecast model

Operational Measures

Average Daily Census

Acute Beds & Swing Beds

-

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0


7.0

4.2

5.4

7.2

6.3

3.1

5.2

9.0

5.3 5.6

7.2 7.7

9.8

6.3



Region 10

-

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0


7.0

5.4

6.3

5.2

9.0

5.3

7.7

6.3



Region 11

-

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0


7.0

4.2

7.2

3.1

5.6

7.2

9.8

Staffing Levels

▪ Hospital’s largest cost – Average FTE’s

❖ Western CAH’s = 191 (Average Salary per FTE = $65,902)

▪ Prepare an FTE analysis

❖ If you cannot benchmark yourself get help

❖ Then take action with a Staffing Plan

❖ Then budget to the agreed plan

▪ Reduce/eliminate agency staffing

▪ Goal is to manage staffing

Other Cost Report Data❖ Salary % of Total Costs

✓ Western CAH Average 44%

❖ Cost Report Adjustments of Total Expenses


❖ Non Reimbursable Cost Center (NRCC) to Total Expenses


93

Medicare Cost Report Worksheet

S-10 Uncompensated Care▪ Uses overall Cost to Charge Ratios (CCR)

▪ But we know excludes:

✓ Selected costs to do business that Medicare does not share in

✓ Physician services

✓ Other sub-providers part of organization

▪ Western CAH’s overall average CCR = 66%

Prepare for the Future

▪ Fine tune operations

❖ Revenue Cycle

❖ Medicare Cash Flow

❖ Staffing Levels

❖ Adequate Medical Staff

❖ Evaluate & consider eliminating unprofitable

services, carefully evaluate new services

❖ Consider Service Line Analysis or Cost Accounting

How do you increase revenues

without increasing costs?

If the future is keeping patients well thus less health

care costs?

What resources do you need?

Is the future focus on Community and Health?

Thank You

Contact Information

Ann King White, CPA

Tammy J Rivera, CPA

[email protected]

[email protected]

mailto:[email protected]

mailto:[email protected]

Documents

acumen Critical Access Hospital Medicare€¦ · Agenda Reimbursement Update Current Status for Critical Access Hospitals (CAH) Medicare Inpatient PPS Final Rule - FFY 2018 Final