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As both the Medicare and the Medi-Cal programs have shifted away from cost reimbursement to a DRG-based program, hospitals are still required to accurately prepare and submit cost reports. Either directly or through SCA Associates, the following services are provided:

  • Prepare and submit Medicare/Medi-Cal cost reports.
  • Review and analyze hospital prepared Medicare/Medi-Cal cost report prior to filing.
  • Perform reimbursement analysis and contractual allowance estimations.
  • Evaluate cost report audit adjustments for appeal determination.

Prepare projections and address appeals related to the Medi-Cal PIRL Program for Non-Contract Hospitals

  • Utilizing both hospital and State data factors prepare a data model to determine potential Medi-Cal Inpatient Peer Grouping Limitation (PIRL) liabilities for “open” time periods prior to the implementation of the Medi-Cal DRG-based system.
  • Based upon the PIRL model, identify potential data errors contained in the hospital’s Medi-Cal cost report that can still be appealed and impact the PIRL calculation.
  • Prepare and submit Medi-Cal PIRL appeals on State issued PIRL liabilities within prescribed time frames.