One singular focus.
We provide everything—every type of support, representation, and service—related to Medicare/Medicaid eligibility and reimbursement.
Medicare/Medicaid Eligibility
If residents and their families are unwilling or unable to cooperate in securing Medicaid coverage, we respond with policies and procedures designed to promote consistent, uniform, and effective methods of addressing these issues at the facility level.
Medicare/Medicaid Reimbursement
We apply fundamental due process rights and an unparalleled understanding of federal preemption to challenge adverse Medicaid and Medicare reimbursement decisions made by state agencies, MCOs, and Medicare contractors.
MCO Compliance
SNFs get underpaid by an estimated 10-30% from MCOs by not being paid timely, inadequate MCO billing systems, inappropriate deauthorizations and other negligence. With MCOs having a permanent role in the Medicare/Medicaid eligibility & reimbursement play, it’s important to understand how to effectively deal with them when they are out of compliance. Despite history, providers do in fact have substantial leverage to compel MCO compliance, but education and timing are everything.
Review the full scope of our firm.
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MEDICAID & MEDICARE SERVICES Everything for Medicare/Medicaid Eligibility and Reimbursement.
No matter what is impacting your revenue sphere, we can resolve issues from simple denials to challenging state budgets. For example:
- Issues with orphaned and incapacitated residents
- Resident qualification
- Late claims submission
- Medicaid denials
- State, MCO and Medicare contractor recoupments
- Receiving timely payments from the state on approved claims
- Negotiating and challenging state budgets
- Challenging states not abiding by CMS rules and regulations
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MCO AND POLICIES & PROCEDURES CONSULTING A Solid Foundation to Protect and Grow Your Business.
Our comprehensive consulting services delivers full-spectrum support to help you develop a systemic program to cover every aspect of your Medicare/Medicaid Eligibility and Reimbursement.
It’s a simple fact that every facility needs a dynamic policies and procedures program if they want to thrive in the regulatory and reimbursement uncertainty of the 21st century.
Our MCO and Policies & Procedures Consulting is more than just forms and admission agreements–it’s a continual educational process to make sure you’re ready for any reimbursement situation you may face.
sb2 Policies and Procedures Consulting includes:
- Managed Care contract review & education
- Onsite audit of a clients’ current policies and procedures and/or existing MCO Contracts
- Strategic and tactical recommendations on improvements needed based on client-centered goals
- Implementation of the correct forms and admissions agreements
- Bi-monthly webcasts to keep clients current on the latest state regulations and new developments from Medicare/Medicaid
- Onsite training to keep clients self-sustaining in the ongoing management of their policies and procedures program
We’re ready to come to your facility at any time. Contact us at 212.203.1334 to get started.
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FLEXIBLE CLIENT RELATIONSHIPS The freedom to think about larger issues.
We restructured our entire business to help you capitalize on every opportunity. Our pricing models make it affordable for your facility to tackle all aspects of your Medicare/Medicaid Eligibility and Reimbursement. Your business needs a partner to ensure that you are being compensated fairly. We want to build a relationship with trust as the foundation, and we hope this fee structure is a step in that direction. Simple. Clear. No hidden charges. Contact us to learn more about our current work platforms.
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GOVERNMENT AFFAIRS Ensure your voice is heard.
Our Government Affairs Group works within both the legislative and administrative processes of government to advance our clients’ agendas. We use practical, real-world experience to assist clients in addressing legislative and regulatory issues that impact their bottom line.
Areas of focus:
- Discretionary projects that could affect Medicare/Medicaid benefits or our clients’ entitlement to them
- Analyzing and summarizing legislative and administrative proposals to assess their impact on our clients’ business operations
- Pursuing legislative agreements in the best interest of our clients, if necessary
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LOCAL SUPPORT We Understand the Nuance of Your Local Region.
To support our full-spectrum service in Medicare/Medicaid Eligibility and Reimbursement, we manage over 30 specialized attorneys to ensure we have a local presence and understand the unique regulatory environment and processes in each state and region. These associated attorneys deploy the strategic guidance of sb2 with equally strong results across the U.S.