Healthcare Payment and Delivery

Ott Cone & Redpath has extensive experience in helping healthcare providers work through complex issues affecting healthcare payment and delivery. With our unique insights into the workings of Medicaid, Medicare, and other public and private payors, we offer our clients a cost-efficient means of addressing their reimbursement challenges. We are actively engaged in the legislative and policy-development processes, and work with our clients to craft strategic solutions to their problems in an effort to improve patient care and provider revenue. We use our knowledge and experience to help our clients foster effective relationships with federal and state officials. Because we are advocates as well as policy experts, we are effective at providing policy, technical, and data support to other advocates, including our clients’ executives, government affairs teams, and provider associations.

Healthcare Reform and Payment and Delivery Models

With the Patient Protection and Affordable Care Act (ACA) and other federal and state initiatives to reform healthcare, medical providers must increasingly rely on legal expertise to guide their decisions. Ott Cone & Redpath is experienced in helping providers navigate reform efforts which affect payment and delivery models.

Healthcare reform, payment, and delivery matters which leading healthcare providers rely on Ott Cone & Redpath for guidance and advocacy include:

  • Accountable Care Organizations (ACOs)
  • IRS Tax-exempt Status
  • Managed Care Organizations (MCOs)
  • Medicare and Medicaid Reform involving various types of federal waivers
  • Medicaid Eligibility Programs

Hospital Supplemental and Enhanced Payments

Ott Cone & Redpath has continued to work with hospitals over the years to find ways to alleviate the negative effects of decreased reimbursement rates. Such efforts include helping hospitals develop and implement supplemental and enhanced payment models. With our in-depth understanding of hospital payment systems such as Medicare and Medicaid, we identify potential waivers, regulations, and other mechanisms for revenue enhancement and seek opportunities to pursue public policy changes which benefit our clients.

Examples of supplemental and enhanced payment issues with which we assist hospitals include:

  • Disproportionate Share Hospital (DSH) Payments
  • Graduate Medical Education (GME) Payments
  • Incentive Payments
    • Electronic Health Record (EHR) Incentive Payments
  • Funding Mechanisms
    • Provider Assessments
    • Certified Public Expenditures (CPEs)
    • Intergovernmental Transfers (IGTs)
  • Supplemental Medicaid Payments

Hospital Payment Rates

Ott Cone & Redpath uses its broad knowledge of hospital payment rates to address fundamental issues on how hospitals are paid. Such issues include:

  • Diagnostic Related Group (DRG) payments
  • Medicare Provider-based Status