Purpose:

20/20 RMP will identify additional Medicaid eligible days to have hospital providers exceed the minimum requirement for 340B DSH qualification and reimbursement.

340B Disproportionate Share Hospital (DSH) - Result of Additional IP Days Discovered

Case Study Challenge:

A Georgia hospital failed to meet the requirement to qualify for 340B Disproportionate Share Hospital (dsh) reimbursement for one Fiscal Year – short nearly 225 days. To avoid duplication of efforts, 20/20 received a complete listing of IP visits and days for the applicable Fiscal Year, which was already calculated and processed by another firm.

Solution:

After all efforts by the original firm were exhausted to identify additional appropriate days to meet the threshold to qualify for 340B DSH reimbursement, 20/20 was hired and proved successful at successfully finding the additional days needed.

Upon receiving the complete list of already identified days, 20/20’s process identified an additional 320 IP days. This resulted in the hospital’s qualification for 340B DSH reimbursement for the applicable Fiscal Year.

Results:

20/20 did not expect to receive any fees unless the provider qualified to receive DSH reimbursement for applicable Fiscal Year based on 20/20’s efforts identifying additional DSH days.

After the appeal efforts that added the additional 320 IP days 20/20 discovered, the hospital recovered nearly $1.8 million dollars.

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