Reimbursement Insight: Anatomy of a Hospital

Presented on:
March 31, 2021 10:00 AM PT
1 hour

Correctly identifying the anatomy of your hospital’s campus is key for successfully navigating reimbursement—especially given the Centers for Medicare & Medicaid Services’ (CMS) site neutrality rules.

Join us to discover key location options as well as important compliance considerations for government and commercial payers in this new era of Hospitals Without Walls. We’ll cover inpatient relocation options, including at home policies, Medicare and state flexibilities, charge-structure considerations, commercial-payer contract challenges, and compliance and risk management considerations, including:

  • How to navigate CMS’s Outpatient Prospective Payment System, effective January 1, 2021
  • Options for diagnostic services under arrangements
  • Steps to locate outpatient services and mitigate CMS’s site neutral payment policies
  • Acute hospital care at home program


Lawrence Vernaglia, LLM, Partner, Foley & Lardner

Lawrence is a partner and health care lawyer with Foley & Lardner LLP where he’s the department chair for the firm’s Industry Teams Department, responsible for overall strategy and leadership across all industry teams. Prior, he served for eight years as chair of the firm’s Health Care Industry Team. Lawrence represents hospitals, health systems, and academic medical centers and a variety of other health care providers.

Valerie A. Rinkle, MPA, CHRI, President, Valorize Consulting LLC

Valerie Rinkle, MPA, CHRI is President of Valorize Consulting and has more than 35 years of experience in health care policy, finance, strategy, and revenue management operations. Her expertise spans all CMS reimbursement methodologies and the operational capabilities necessary to effectively achieve accurate and defensible payment. She has extensive hospital chargemaster, OPPS and physician fee schedule, and provider-based department experience.

Paul Holden, FHFMA, Partner, Health Care Consulting, Moss Adams

Paul has been in public accounting since 2003. He provides business assurance and reimbursement consulting services to health care providers in acute and post-acute settings throughout the western United States. Paul is well-versed in preparing Medicare and Medicaid cost reports, assisting clients during third-party audits, formulating appeals of audit issues in connection with cost reports, and assisting Critical Access Hospitals, Rural Health Clinics, and Federally Qualified Health Centers with billing and reimbursement issues.

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