Case Studies > Capital Cost Recovery

Health system recovers $1.7M of capital costs for two recently constructed facilities

Key Takeaways
  • A large multi-facility health system had not received capital pass-through funds from CMS for new facilities

  • Titan Health educated health plans and obtained a ruling letter from the Medicare Administrative Contractor in favor of Titan's interpretation of the regulations

  • Titan was able to recover over $1.7M for the two facilities within just 5 months

Overview

While researching a large multi-facility health system located in the western United States, Titan Health observed that two of their facilities were built and opened within the past 5 years. Although the system had previously received capital pass-through funds from CMS for the new facilities, Titan determined that they had not pursued the pass-through funds available from regional Medicare Advantage (MA) plans.

The Challenge

Titan began contacting regional MA plans and requesting the capital pass-through funds to which the health system was entitled. Many of these plans were unaware of this financial obligation and many disputed Titan’s interpretation and application of the CMS regulations regarding Capital Cost pass-through reimbursement.

The Solution

Using minimal information supplied by the two hospitals (Cost Reports and Inpatient Days), Titan Health proceeded to educate the health plans on the process and rationale for the amounts due to the health system. Further, a ruling letter was obtained from the regional Medicare Administrative Contractor (MAC) containing a favorable finding on Titan’s interpretation of the regulations.

Titan served as an intermediary between the health system and the payors, obtaining reimbursement from some of the plans and negotiating settlements with others.

The Results

By collaborating with the hospitals and the regional MA plans, Titan was able to recover over $1.7M for the two new facilities within just 5 months.

By the Numbers

$1.7 Million

Amount Recovered