An Inpatient Rehabilitation Hospital ("IRF") was dissatisfied with their current CPA firm and engaged TFG Consulting to prepare the Medicare Cost Report as the due date was rapidly approaching. After the cost report was complete, we met with the provider's CFO to review recommended revenue cycle improvements. While establishing controls to ensure that Medicare Payments were paid at the proper amount, we discovered that the amount that the provider was paid for each CMG was far less than the expected reimbursement according to our manual calculations. After further examination, we determined that the intermediary had paid the provider based upon the incorrect CBSA as the provider relocated 18 months earlier in the aftermath of Hurricane Katrina.


We brought the mistake to the attention of the intermediary and worked with the intermediary to establish a methodology to re-price 18 months of claims data using the wage-index of the proper CBSA.


Our efforts combined with dogged pursuit of the issue by the client with the intermediary resulted in additional funds in excess of $1 million dollars being paid within 90 days. The provider's revenues also increased by approximately 14% going forward.