At Gold Wiseman, we help healthcare providers maximize their Medicare and Medicaid reimbursements through strategic analysis, compliance support, and expert consulting. Our experienced professionals understand the complexities of government reimbursement systems and work closely with hospitals, clinics, and healthcare organizations to optimize payments, reduce audit risks, and maintain full compliance with federal and state regulations.
Disproportionate Share Hospital (DSH) Analyses
The Medicare and Medicaid Disproportionate Share Hospital (DSH) programs provide hospitals with additional reimbursement for treating indigent and underserved populations. However, inaccurate reporting or missed opportunities can lead to lost funding.
At Gold Wiseman, we help hospitals:
- Identify eligible Medicaid days to maximize DSH participation
- Prepare and file required DSH surveys and reports
- Stay up to date with state regulatory requirements and filing procedures
Our team works closely with regulators to ensure your hospital receives all available funding and maintains compliance with DSH program rules.
Medicare and Medicaid Reimbursement Consulting
Medicare and Medicaid reimbursement remain some of the most complex challenges facing healthcare providers today.
With decades of experience serving hospitals, skilled nursing facilities, home health agencies, and other healthcare providers, Gold Wiseman offers comprehensive consulting to help your organization navigate these systems efficiently.
Our professionals prepare and review Medicare cost reports, analyze reimbursement opportunities, and ensure your documentation meets intermediary requirements. We’re experts in identifying strategies to maximize reimbursement while maintaining compliance with ever-changing healthcare regulations.
Medicare Critical Access Hospital (CAH) Designation
Becoming a Medicare Critical Access Hospital can significantly improve reimbursement for small and rural hospitals. This cost-based reimbursement has helped many facilities regain financial stability.
Gold Wiseman assists hospitals by:
- Performing financial analyses for CAH designation
- Providing reimbursement and billing consultations
- Preparing Medicare cost reports for submission
Our team helps you navigate the process from start to finish, ensuring your hospital meets all qualification criteria.
Medicare Geographic Reclassifications
Hospitals may qualify for increased Medicare funding through geographic reclassification, which adjusts the wage index and standardized payment amounts based on location.
Gold Wiseman provides expert assistance with:
- Reclassification applications
- Supporting documentation and data preparation
- Liaison services with Medicare Administrative Contractors (MACs)
We help hospitals secure higher reimbursement rates by ensuring their classification accurately reflects their regional labor market.
Medicare Provider-Based Requests
Provider-based facilities often receive greater reimbursement than standalone entities — but achieving this status requires detailed documentation and compliance with specific regulations.
Our experts help healthcare organizations:
- Prepare and organize provider-based requests
- Develop required supporting documentation
- Coordinate with state, federal, and fiscal intermediaries
With Gold Wiseman, you can secure provider-based status efficiently while minimizing delays in approval and cash flow.
Medicare Rural Referral Center (RRC) Applications
Hospitals that qualify as Medicare Rural Referral Centers can gain increased inpatient reimbursement and favorable reclassification treatment.
Gold Wiseman assists hospitals by:
- Preparing and submitting RRC applications
- Compiling and organizing supporting documentation
- Liaising with the Medicare Administrative Contractor (MAC)
Our team ensures your hospital’s application is complete, compliant, and optimized for approval.
Medicare Sole Community Hospital (SCH) Applications
Sole Community Hospital (SCH) designation provides higher reimbursement for hospitals located at least 25 miles from similar facilities.
Gold Wiseman helps you:
- Prepare and file SCH designation requests
- Develop and organize required documentation
- Communicate with the MAC for approval
We make the process smooth and efficient, helping you access the enhanced reimbursements your hospital deserves.
Medicare Wage Index Reporting and Review
Accurate wage index reporting is critical to ensuring proper reimbursement under the Medicare program. Errors in data submission can lead to significant payment reductions or compliance issues.
Our team assists with every step of the process:
- Compiling data for inclusion in cost reports and occupational mix surveys
- Performing detailed analyses to ensure data accuracy
- Reviewing public use files and requesting corrections when necessary
With Gold Wiseman, your wage index data remains precise, compliant, and optimized for maximum reimbursement.
Merger and Acquisition Reimbursement Consulting
As healthcare payment models evolve, many organizations are exploring mergers and acquisitions to maintain efficiency and scale. These transitions involve complex regulatory, accounting, and reimbursement challenges.
Gold Wiseman offers strategic guidance to help providers navigate these changes, from compliance and cost reporting to post-merger reimbursement planning. Our consultants ensure that your organization’s financial strategy aligns with long-term growth and compliance goals.
TRICARE Capital and Direct Medical Education Cost Reimbursement
Hospitals participating in the TRICARE/CHAMPUS DRG-based payment system may be eligible for additional reimbursement for capital and direct medical education costs.
Gold Wiseman assists with:
- Preparing and submitting TRICARE reimbursement requests
- Ensuring accurate cost reporting and compliance
- Helping hospitals secure all eligible additional funding
Additional Reimbursement Services
Our comprehensive healthcare reimbursement services also include:
- Accounts Receivable Contractual Allowance Computation and Analysis
- Legislative Reimbursement Analysis
- Medicare & Medicaid Cost-Based Reimbursement
- Medicare Intern and Resident Reimbursement
- Medicare S-10 Analysis & Review
- Medicare SCH & MDH Status
- Volume Decrease Adjustment Requests
- Medicare Transplant Reimbursement
- Medicare Uncompensated Care Analysis & Review
- Service Line Reimbursement Evaluation
- Cost Allocation Methods Analysis
Partner with Gold Wiseman for Reimbursement Success
With decades of healthcare consulting experience, Gold Wiseman is your trusted partner for Medicare and Medicaid reimbursement optimization. We combine deep technical knowledge with personalized support to help your organization achieve financial strength, compliance, and sustainability.
Our team is ready to help you maximize your reimbursement potential — while ensuring accuracy, transparency, and peace of mind.