Health System Recovers $1.7 Million in Capital Costs for Two Newly Constructed Facilities

Key Takeaways

• Multi facility health system had not received eligible capital pass through reimbursement from Medicare Advantage plans

• Titan Health secured regulatory clarification supporting reimbursement eligibility

• More than $1.7 million recovered for two facilities within five months

Overview

During proactive research for a large multi facility health system in the western United States, Titan Health identified two hospitals that had been constructed and opened within the previous five years. While the organization had received capital pass through funding from CMS under traditional Medicare, Titan determined that reimbursement opportunities from regional Medicare Advantage plans had not been pursued.

The Challenge

Titan initiated outreach to regional Medicare Advantage plans to request capital pass through payments owed to the health system. Many plans were unfamiliar with their responsibility to provide these reimbursements and disputed Titan’s interpretation of CMS regulations governing capital cost pass through payments. The absence of consistent payer understanding created significant barriers to recovery.

The Solution

Working with limited documentation provided by the hospitals, including cost reports and inpatient day data, Titan developed a structured reimbursement case and educated health plans on the regulatory basis supporting payment obligations.

To strengthen the position, Titan obtained a formal ruling letter from the regional Medicare Administrative Contractor confirming a favorable interpretation of the applicable regulations. Acting as an intermediary between the health system and participating payers, Titan negotiated directly with plans, securing reimbursement from some and reaching negotiated settlements with others.

The Results

Through coordinated collaboration with both the health system and regional Medicare Advantage plans, Titan recovered more than $1.7 million in capital cost reimbursement for the two facilities within a five month period. The engagement ensured the organization received funding aligned with federal reimbursement policy while establishing a clearer pathway for future capital recovery opportunities.

By the Numbers

$1.7 Million recovered in capital pass through reimbursement.