Medicaid DSH and Supplemental Funding Support

Revenue Entitlement / Medicaid DSH and Supplemental Funding Support

Toyon evaluates all allowable costs to retain essential revenue supporting care to the nation’s most critically vulnerable patient populations, and to minimize the risk of funds returned to the state and federal government. 

In California, we prepare reports for both Public/District and Non-Public Hospitals to California Department of Health Care Services (DHCS) and the California Department of Health Care Access and Information (HCAI) to secure funding received through Medi-Cal DSH, Quality Assurance Fee (QAF), and various programs specifically for California’s public hospitals. Toyon maintains a close relationship with the California Association of Public Hospitals (CAPH) which enables us to closely monitor new programs and supplemental funding. 

Importantly, Medicaid payment and cost data is publicly available information and accessible to industry stakeholders evaluating the Medicaid rates. Our scope of services ensures hospitals appropriately recognize all allowable costs to demonstrate the true margin of treating Medicaid and uninsured patients.  

Non-Public 

  • Review Medicaid Inpatient Utilization Rate (MIUR) and Low-Income Utilization Rate (LIUR) reports issued by DHS, used for DSH and SB1732 reimbursements. 

  • Review of filed HCAI Annual Disclosure Report for possible adjustments/corrections needed for Report 12. 

  • Review adequacy of waiver DSH and Safety Net Care Pool (SNCP) funds received/receivable, including supporting annual DSH survey filing and audit support. 

  • Reconciliation of Medi-Cal Managed Care days to the MMIS system for HQAF (Private Hospitals) 

Public Hospitals (Includes District) 

  • Hospital Payment Rate Workbook (P14) preparation, review, and audit support. 

  • Review of Medi-Cal Cost Reports adjustments that can impact DSH funding and file applicable appeals. 

  • AB85 Realignment preparation, review and audit support. 

  • AB915 Medi-Cal outpatient fee-for-service / PNPP (Physician Non-Physician Practitioner Program) supplemental claims filing, review and support for CPE reimbursement, including audits of MMIS data for final settlement. 

  • Point-of-Service Medicaid Eligibility Listing. 

  • GPP filing, review and support to secure accurate funding from the program. 

  • California Association of Public Hospitals (CAPH) modeling and forecasting for current and future Medicaid supplemental funding programs.  

  • Analysis of accrued Waiver-related funds for proper recording for financial reporting purposes, including IGT (Inter-Governmental Transfer), GPP (Global Payment Program), EPP (Enhanced Payment Program), and QIP (Quality Improvement Program)  

Medicare Disproportionate Share (DSH) Entitlement

Our team utilizes business intelligence tools to accurately report your DSH entitlement.

Transplant Services

We partner with you to assess compliance with the complex transplant reporting requirements and accuracy of the requested revenue entitlement.

Medicare Uncompensated Care

Our team accurately reports your uncompensated care entitlement utilizing our proprietary business intelligence tools.

Medical Education

Our team partners with you to accurately manage all aspects of DGME/IME finance and reimbursement. 

Medicare Bad Debt

Our team expertly identifies, captures, and reports revenue entitlement to assure compliance with complex regulatory requirements and accurate revenue entitlement.

Medicaid DSH and Supplemental Funding Support 

Toyon Associates efficiently prepares cost data to secure Medicaid revenue while maintaining compliance. 

Wage Index and Occupational Mix Services

We thoroughly analyze your wage, benefit, contract labor and home office data for accurate reporting.

Medicare and Medicaid Appeals

Save hours by letting us handle regulation navigation and preparation of accurate, compliant appeals.

  • “Year after year, Toyon demonstrates exemplary client support and dedication to our organization. They are not only receptive to our needs, they also go above and beyond in project execution and making sure we are up to date on all industry regulations.”

    Vice President Reimbursement, Large Multi-State For-Profit Health System

  • "I truly feel that Toyon's Absolute® suite will make your reporting more efficient... once you begin working with Absolute, you'll wonder how you ever worked without it."

    Manager Regulatory Compliance, Methodist Health System

  • "Toyon consistently delivers forward-thinking, value-added results with exemplary customer service. From beginning to end on each project, our entire team, from staff to executive, has felt 100% taken care of."

    Vice President of Strategic Planning and Revenue Cycle, 500+ CA-based Acute Care Hospital

  • "The result [of partnering with Toyon]... cost reports completed on time and on budget, audit adjustments had virtually disappeared, and the system had achieved annual reimbursement improvements in the $10s of millions."

    Director of Reimbursement, Large Multi-State Health System

  • "We have worked with Toyon on a variety of projects over the years and they have become an important and trustworthy part of our team. We use their Absolute® product at many of our facilities and it is truly best in class."

    Vice President of Reimbursement & Revenue Integrity, 75+ Nationwide Healthcare System

Get started with Toyon today.

info@toyonassociates.com
(888) 514-9312

Concord CA | Costa Mesa CA | Knoxville TN