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1 Table of contents 1 WELCOME TO QUALITY REIMBURSEMENT SERVICES QUALITY REIMBURSEMENT SERVICES Introduction RURAL FLOOR BUDGET NEUTRALITY ADJUSTMENT Background Who qualifies for RFBNA reimbursements? Conclusions and Recommendations THREE THINGS YOU NEED TO KNOW ABOUT DISPROPORTIONATE SHARE (DSH) IN (1) Impact of CMS Final Regulations on your DSH calculations (2) Impact of an Allina Ruling on Medicare Part C Reporting (3) SSI Enrollment Conclusions and QRS Recommendations TRANSFER DRGs: THE IMPACT OF NEW STATUTES ON SHORT TERM ACUTE CARE HOSPITALS What are Transfer DRGs and why do they exist? Impact of expanded Transfer DRG classifications The objective is to minimize transfers and maximize discharges Conclusions and Recommendations OUTLIER PAYMENTS: RECOVERING THE COSTS OF EXTRAORDINARILY EXPENSIVE CASES Background Outlier Reconciliation Adjustments Conclusions and Recommendations THREE TIPS FOR SUCCESSFULLY COLLECTING MEDICARE BAD DEBT... 12

2 7.1 There are three elements to successfully writing-off Medicare Bad Debt on your cost report Conclusions and Recommendations B DRUG PRICING PROGRAM RECENT DEVELOPMENTS AND WHAT THEY MEAN TO MEDICARE HOSPITALS Background Recent Development and ACA Impact on 340B Programs Conclusions and Recommendations CAREERS Equal Opportunity Statement Currently Open Positions CONTACT US QRS Locations Page 2

3 1 WELCOME TO QUALITY REIMBURSEMENT SERVICES Page 3

4 2 QUALITY REIMBURSEMENT SERVICES 2.1 Introduction Quality Reimbursement Services (QRS) has been reviewing Medicare and Medicaid cost reports for more than twelve years.our corporate office is located in Arcadia (CA). We also have offices located in Birmingham (AL), Scottsdale (AZ), Los Angeles (CA), Colorado Springs (CO), Jacksonville (FL), Chicago (IL), Detroit and Shelby Township (MI), Guttenberg (NJ), Dallas/Fort Worth (TX) and Spokane (WA). All of QRS' offices are dedicated to providing its' clients with the most comprehensive, interactive reimbursement assistance possible. Our corporate philosophy combines our experience in the Medicare and Medicaid programs with a commitment to keeping up with the latest news and court decisions for the benefit of our clients. We believe in a personal hands-on approach with our clients which fosters long term relationships, an aspect of which is to regularly share information with our clients. QRS represented over 130 of 667 hospitals that participated in a $666.1 million settlement from the U.S. Department of Health and Human Services in a dispute over Medicare DSH reimbursement. This is believed to be the largest Medicare settlement in history and was concluded in March 2008 after more than four years of litigation. We were actively involved in the litigation and subsequent settlement negotiations. Through the years, we have gained extensive expertise in the appeals process, not only at the Provider Reimbursement Review Board (PRRB) level, but also at the Federal District and Appeals court. Our work with providers throughout the country and our professional reputation have helped us maintain a very amicable working relationship with many Page 4

5 representatives of Medicare Fiscal Intermediaries and the Centers for Medicaid and Medicare Services (CMS) which directly benefits our clients. Additionally, we have created an extensive network of information resources, which helps to better prepare us for the representation of our clients. We are in direct contact with many of the leading health care law firms in the nation and often utilize their services in litigating Medicare and Medicaid in Federal and State Appeal forums. We also regularly participate in educational forums to update our knowledge on the issues currently under dispute and any upcoming litigation as well. QRS consultants are active members of the Health Care Financial Management Association (HFMA) and the prestigious American Health Lawyers Association (AHLA). Click here to: REQUEST ADDITIONAL INFORMATION FROM QRS 3 RURAL FLOOR BUDGET NEUTRALITY ADJUSTMENT 3.1 Background. The 1997 Balanced Budget Act included a Budget Neutral Provision for CMS. This was to end decades of quarreling about how Medicare would equitably reimburse hospitals for uncompensated care. By 1998, CMS came out with the Budget Neutrality Adjustment. This eliminated the Rural vs. Urban reimbursement methodology and created fixed costs (DRG) for hospital in-patient programs, taking into consideration the Wage Index as well as many other factors. From 1999 through 2006, CMS increasingly understated the standardized amounts from the Budget Neutrality Adjustment. In 2007, CMS adjusted its payment schedule to correct the understatements, but did so only for that year not admitting to underpayments from 1999 through 2006, nor for adjusting the schedule forward for years beyond In January of 2011, the US Court of Appeals decided in favor of the providers in Cape Cod Hospital et al, v. Kathleen Sebelius. And by September 2011, CMS stated that Good Faith Settlement negotiations may begin, and a schedule of incremental reimbursements was created to compensate hospitals for DRG underpayments from 1998 through Who qualifies for RFBNA reimbursements? All Medicare agencies in the US and Puerto Rico except Critical Access Hospitals - qualify for this appeal. Sole Community Hospitals have a modified payment schedule, as does Puerto Rico. But all non-ca hospitals may appeal their DRG amounts from FY1998 FY2011. Even hospitals that are no longer in service have recourse, as long as they show DRG between 1998 and Typically, they will have a law firm or accounting firm dealing with the estate and any funds that result from this appeal may go toward paying debt. Page 5

6 3.3 Conclusions and Recommendations. Unlike many on-going reimbursement programs (like Disproportionate Share, Bad Debt, 340B, etc.), the RFBNA appeal is a one-shot windfall opportunity. Hospitals may file their own appeals with the Provider Reimbursement Review Board and later in Federal Court. However, given the backlog of cases in Federal Court the queue is several years long. Most hospitals that are appealing RFBNA are using law firms or consulting firms that gather many hospitals under the same appeal, so they can negotiate a settlement with CMS from a position of strength. If you are considering using a third party to handle this appeal for you, they should be able to give you a fairly accurate estimate of what your BNA (incremental reimbursements) should be. This is done by taking your DRG for the fiscal years in question, and multiplying these payments by the percentages developed by CMS, which defines the shortfall that is due to the provider for each year. You should note that for all cost reports that have been closed by Notice of Program Reimbursement (NPR), the provider must appeal the BNA amounts within 180 days of filing the NPR. Quality Reimbursement Services, Inc. has been consulting hospitals on matters dealing with Medicare and Medicaid reimbursements since We work on a contingency basis, requiring no up-front or maintenance charges for our services. We would be happy to meet with you, and review your circumstances to see if we may be of service. Click here to: REQUEST ADDITIONAL INFORMATION FROM QRS 4 THREE THINGS YOU NEED TO KNOW ABOUT DISPROPORTIONATE SHARE (DSH) IN (1) Impact of CMS Final Regulations on your DSH calculations. On Friday, August 2, 2013, CMS announced their long-awaited Inpatient Medicare Regulations for Federal FY As expected, the biggest change involves the way DSH will be calculated beginning October 1, 2013 (beginning of the Federal Fiscal Year). As expected, DSH will be made up of two parts: Part I. 25% of DSH payments will come from the traditional method of calculation (see DPP below). Part II. 75% of DSH payments will come from an uncompensated care pool aggregated from ALL DSH hospitals. Shares from this pool will be distributed to DSH hospitals based on the ratio of the hospital s uncompensated care to the total amount of uncompensated care provided by all Medicare DSH hospitals. Page 6

7 The biggest news to come from these final regulations, is HOW the total uncompensated care pool is calculated. Essentially, CMS has taken total Medicaid and SSI days from the cost reports of all Medicare hospitals in FY2011. This totals approximately $9 Billion. So, 75% of your future DSH payments will depend entirely upon the number of Medicaid and SSI days you can confirm on your cost report (relative to the $9 Billion uncompensated pool). But, before you can appeal any DSH amounts, you must still pass the DPP threshold. The threshold for most hospitals is 15% using the basic formula for calculating DPP: Medicare/SSI Days + Medicaid/Non-Medicare Days = DPP* Total Medicare Days Total Patient Days If your DPP is at least 0.15 (15%), you qualify for the DSH adjustment. Your DPP is factored into some IPPS calculations to provide a DSH value, just as in the past. This value will now be multiplied by 0.25 to give you Part I of your DSH adjustment. Passing the DSH threshold also entitles you to a share of the uncompensated care pool. For your next cost report, your share of the pool is already fixed. It will be the ratio of your Medicaid and SSI days (from 2011) as a percentage of the $9 Billion pool. 4.2 (2) Impact of an Allina Ruling on Medicare Part C Reporting. Providers received a limited victory in 2011, when Federal Court ruled in Northeast Hospital v. Sebelius, that Medicare Part C (Medicare Advantage) belongs in the numerator of the Medicaid DPP fraction instead of the denominator of the Medicare fraction. It was a limited victory because it only applied to pre-2004 cost reports for those hospitals in the appeal. The Allina case, currently in circuit court, seeks to extend this Part C status beyond 2004 to present. In order to more fully understand the impact this case could have, we simply have to plug some numbers into the DPP formula, and see the difference. For demonstration purposes, consider a hospital with: 5 Medicare/SSI days; 40 Medicare Part A days; 10 Medicare Part C days (50 total Medicare days); 5 Medicaid Days; and 100 Total Patient Days. The DPP formula would look like this: 5 SSI Days + 5 Medicaid, Non-Medicare Days = DPP 50 Medicare Part A & C Days 100 total Patient Days Written another way the above formula would read: = 0.15, or 15% Now, if you move the Medicare Part C days from the denominator of the Medicare fraction, to the numerator of the Medicaid fraction (per the Northeast ruling), your formula would look like this: 5 SSI Days + 5 Medicaid + 10 Medicare Part C Days (15 total) 40 Medicare Part A Days 100 Total Patient Days Page 7

8 This configuration would be: = or 27.5% This represents an increase of 83%! Granted, this increase would only apply to the 25% portion of your DSH adjustment. But the final adjusted formula could be enough to push some hospitals over the DPP threshold, enabling them to participate in DSH for the first time. 4.3 (3) SSI Enrollment. Hospitals generally benefit, any time they can add numbers to a numerator in the DPP formula. Above, we see how a favorable Allina ruling will accomplish this. So will adding SSI days to the Medicare fraction of the formula. This is accomplished by identifying patients who have Medicare status, but should have been registered as SSI patients. Sometimes they don t know they are SSI eligible. Sometimes they have applied for SSI, but were wrongfully denied. Running patient records through an SSI database (as well as others) will very often reveal candidate mislabeled SSI patients. Some detective work will confirm the wrong classification. Documentation and proper filing will then increase the hospital s DSH appeal. 4.4 Conclusions and QRS Recommendations. Hospitals typically scour for additional Medicaid and SSI eligible inpatient days to include in their DSH calculations. These days are now more valuable than ever before. Therefore, we present the following recommendations: Dedicate 2013 to maximizing your uncompensated care, uncovering every possible inpatient Medicare and SSI day. Leave no stone unturned, because these days represent the only tool left to maximize your DSH adjustments. Make sure you are represented in the Allina appeal. This case could have any number of outcomes, but we feel that most likely, the Court will find for the hospitals (like they did for Northeast). However, only those hospitals that join the appeal will get the benefit of this ruling. If you use a consultant that works entirely on contingency, you can only win regardless of the final decision. Quality Reimbursement Services, Inc. has been consulting hospitals on matters dealing with Medicare and Medicaid reimbursements since We work primarily on a contingency basis, requiring no up-front or maintenance charges for our services. We would be happy to meet with you, and review your circumstances to see if we may be of service. Click here to: REQUEST ADDITIONAL INFORMATION FROM QRS Page 8

9 5 TRANSFER DRGs: THE IMPACT OF NEW STATUTES ON SHORT TERM ACUTE CARE HOSPITALS 5.1 What are Transfer DRGs and why do they exist? Transfer DRGs are the outgrowth of the Balanced Budget Act of Studies conducted by CMS during the 1990 s concluded that Medicare was being overcharged in some instances, when hospitals discharged patients to other Medicare facilities and both entities claimed full DRG reimbursement. So, out of 559 total DRGs at the time, CMS initially designated 10 as Transfer DRGs in FY99. When one Medicare facility transferred a patient from this group to another Medicare facility, each entity would get a pro-rated per diem not to exceed 100% of the DRG reimbursement amount. By 2004 there were 29 Transfer DRGs. By 2006 the classification expanded to 182. By early 2013, nearly all 749 DRGs are considered Transfer DRGs 5.2 Impact of expanded Transfer DRG classifications. Revenue loss, as a result of this expansion of Transfer DRGs in 2013, will obviously vary greatly from hospital to hospital. In 2006, when Transfer DRGs grew from 29 to 182, the overall reduction in payments was about 0.9%*. The jump in Transfer DRG numbers in 2013 represents more than three times the impact felt in Fortunately, there are several things hospitals can do to mitigate much of this revenue loss. 5.3 The objective is to minimize transfers and maximize discharges. Medicare s Post Acute Care Transfer (PACT) Policy reduces the payment to hospitals that transfer patients to certain post-acute care settings. Hospitals trigger the PACT policy when they report one of the six discharge status codes in conjunction with a Transfer DRG. These codes are: (03) Medicare skilled nursing facility with Medicare certification in anticipation of skilled care (05) Designated cancer center or children s hospital (06) Home under care of organized home health service organization in anticipation of covered skilled care (62) Inpatient rehabilitation facility, including distinct part unit of a hospital (63) Long-term care hospital (65) Psychiatric hospital or psychiatric unit of a hospital Page 9

10 49% of hospitals with underpayment determinations cited discharge disposition as a reason, according to the American Hospital Association s RACTrac survey results from the third quarter of 2011**. Further, hospitals are leaving money on the table if they aren t going back and tracking patients after discharge, to make sure they were in fact, admitted to the other institutions. For example, a patient s family may decide they want to care for the patient rather than send him or her to a Skilled Nursing Facility. When this happens the transferring hospital is likely underpaid when it reports any discharge status code that triggers the PACT policy rather then the 01 code for home discharge. Transfers to home health agencies also often yield underpayments because the PACT policy is triggered only when these services occur within three days of discharge and when they are related to the previous hospital s admission. When home health agencies don t begin service within three days of discharge, billers must assign code CC43, which also allows the hospital to receive the full DRG payment 5.4 Conclusions and Recommendations. The expansion of Transfer DRGs will undoubtedly lessen DRG discharge payments to hospitals from this point going forward. Hospital Discharge Planners, already challenged by changing regulations and CMS requirements, will be pushed even harder now that almost all DRGs have transfer status. The key is tracking patients after they leave the hospital, to make sure they indeed check into a qualified treatment program within 3 days of release. If your organization lacks the resources to do this, you should consider using a consultant that specializes in this area. Specific recommendations are: Protect yourself if you hire a consultant to handle Transfer DRG issues. You could easily pay more in fees than you receive in incremental savings. If the consultant works on a contingency basis, you can t lose, because the fee is tied to a percentage of savings achieved as the result of services. Make sure your Transfer DRG consultant has the latest technology to identify opportunities. They will need special software that bumps patient files against various government databases to identify anomalies. The consultant will then need detective skills to confirm legitimate changes to discharge status and then make successful appeals to CMS Quality Reimbursement Services, Inc. has been consulting hospitals on matters dealing with Medicare and Medicaid reimbursements since We work primarily on a contingency basis, requiring no up-front or maintenance charges for our services. We would be happy to meet with you, and review your circumstances to see if we may be of service. * SMA Informatics/CaseMix Consulting, Dec Page 10

11 ** Fortherecord.com/archives/022712p14.shtml, Feb Click here to: REQUEST ADDITIONAL INFORMATION FROM QRS 6 OUTLIER PAYMENTS: RECOVERING THE COSTS OF EXTRAORDINARILY EXPENSIVE CASES 6.1 Background. In creating the foundation for the Prospective Payment System back in 1985, Congress realized the need to reimburse hospitals for cases incurring extraordinarily high costs. These cases are called outliers because they deviate from the normally accepted DRG amounts, and the difference remained uncompensated. In order to provide hospitals some relief for providing these uncompensated services, Congress directed CMS to reimburse hospitals for outliers by setting a target equal to 5.1% of total DRG for outliers for all Medicare hospitals. Since 2003, CMS has met this target only once. So we can only assume that many Medicare hospitals are not taking advantage of this opportunity. 6.2 Outlier Reconciliation Adjustments. Under 42 CFR (i)(4), for discharges occurring on or after August 8, 2003, high cost outlier payments may be reconciled upon cost report settlement to account for differences between the Cost Coverage Ratio (CCR) used to pay the claim at its original submission by the provider, and the CCR determined at final settlement of the cost reporting period during which the discharge occurred. Subject to the approval of the CMS Central Office, a hospital s outlier claims will be reconciled at the time of the cost report final settlement if they meet the following criteria: 1. The actual operating CCR is found to be plus or minus 10 percentage points from the CCR used during the time period to make outlier payments (original cost report filing or latest audit), and 2. Total outlier payments in the cost reporting period exceed $500,000 It s important to note that the above 10% rule means that if a provider, meeting all other criteria, shows CCR totaling more or less than 10% of the> previously filed or audited CCR - that provider likely will have its outlier payments audited and recalculated. But even if a hospital does not meet the criteria for reconciliation, subject to approval of the Regional and Central Office, the Medicare contractor has the discretion to request that a hospital s outlier payments in a cost reporting period be reconciled if the hospital s most recent cost and charge data indicate that the outlier payments to the hospital were significantly inaccurate. Page 11

12 6.3 Conclusions and Recommendations. We believe it is wise for all providers to appeal their acute care outlier payments. CMS historically fails to pay hospitals the 5.1% of total DRG payments that have been withheld from providers for this purpose. If your hospital has been subjected to outlier reconciliation adjustments we recommend that the adjustments be reviewed in depth to determine if the revised outlier payment amounts have been accurately determined. The review should encompass all inpatient discharges and transfer payments. Additionally we recommend that these providers appeal the outlier reconciliation adjustments. The grounds for appeal would include the correction of any errors found and challenging CMS on the arbitrary and capricious nature of the 10% threshold that was used to identify the hospital for the reconciliation adjustments. Quality Reimbursement Services, Inc. has been consulting hospitals on matters dealing with Medicare and Medicaid reimbursements since We work entirely on a contingency basis, requiring no up-front or maintenance charges for our services. We would be happy to meet with you, and review your circumstances to see if we may be of service. Click here to: REQUEST ADDITIONAL INFORMATION FROM QRS 7 THREE TIPS FOR SUCCESSFULLY COLLECTING MEDICARE BAD DEBT First, we need to define our terms. Medicare Bad Debt is derived from: Deductibles and Coinsurance amounts uncollectible from Medicare beneficiaries after reasonable collection efforts. Medicare Bad Debt is not derived from: Uncollected deductibles and coinsurance amounts from private pay patients, or any other non-medicare beneficiaries; Medicare Advantage patients; charity, courtesy or third-party allowances; nor uncollected amounts due from other payers including disputed Medicare claims. 7.1 There are three elements to successfully writing-off Medicare Bad Debt on your cost report. 1. Determining Indigent Patients. Dual eligible Medicare/Medicaid beneficiaries are automatically determined indigent (no collection effort necessary). However, you must bill Medicaid for proof of eligibility and offset Medicaid payments. Non-Medicaid indigence must be determined by the provider (not the patient). The provider must take into account the total resources available to the beneficiary that can be converted into cash and unnecessary to the patient s daily living. It is the provider s responsibility to determine that no source other than the patient would be legally responsible for the Page 12

13 patient s medical bill, and the patient s file should have all back-up information to substantiate the determination. 2. Reasonable Collection efforts must be documented (e.g. collection letters, phone calls, collection agency efforts). The provider s Collection Policy must be consistent among all payer types. DO NOT INCLUDE A MEDICARE COLLECTION SECTION WITHIN YOUR POLICY. This will indicate that you are not consistent in collections, and your Medicare bad debts may be disallowed at audit. If, after reasonable and customary attempts to collect a bill, and the debt remains more than 120 days from the date of the first bill, that bill may be deemed uncollectable. 3. Audit Documentation must include the following: 1. How the indigent determination was made (Medicaid/Non-Medicaid), 2. Copies of bills 3. Bad Debt Logs include 1. Patient s name 2. HIC number 3. Date of service 4. How the patient was deemed indigent 5. Date the first bill was sent 6. Date the bad debt was written off 7. Remittance advice date 8. Deductible and coinsurance amount 9. Total Medicare bad debt for the cost report 10. Partial Payments 7.2 Conclusions and Recommendations. For most hospitals, Medicare Bad Debt collection is incredibly resource intensive, and often the results hardly seem worth the effort. However, with the economy being what it is, very few providers can afford NOT to aggressively pursue the remedy. Attention to detail is critical, because CMS will look for errors or omissions in the report so they may summarily dismiss as many appeals as possible. The key is preparing an accurate Bad Debt Log that includes: Accounts Receivable Data Payment Histories Patient Eligibility You should have software that bumps patient case histories against relevant databases to look for anomalies. You need to be able to work with your Medicare Administrative Contractor (MAC) to resolve issues. And obviously, you need to be able to reopen and appeal cost Page 13

14 reports. If you lack the resources internally to cover all these bases, you should consider using a consultant that specializes in this kind of detective work. Quality Reimbursement Services, Inc. has been consulting hospitals on matters dealing with Medicare and Medicaid reimbursements since We work primarily on a contingency basis, requiring no up-front or maintenance charges for our services. We would be happy to meet with you, and review your circumstances to see if we may be of service. Click here to: REQUEST ADDITIONAL INFORMATION FROM QRS 8 340B DRUG PRICING PROGRAM RECENT DEVELOPMENTS AND WHAT THEY MEAN TO MEDICARE HOSPITALS 8.1 Background. 340B is a Federal drug-pricing program intended to provide relief to facilities that care for the poor and medically underserved. It is operated by the Office of Pharmacy Affairs (OPPA) in the Health Resources and Services Administration (HRSA). 340B requires that drug manufacturers provide significant discounts to participating Covered Entities for covered outpatient drugs. Manufacturers that participate in Medicaid must also participate in the 340B program. Manufacturers must provide front-end discounts on covered outpatient drugs, purchased by a participating, government-supported facility (Covered Entity). The 340B drugs may be billed to end-users at the retail price, with the Covered Entity pocketing the difference. However, the Drug Manufacturing Lobby is now pushing back, and Congress is studying the situation for possible change. Covered Entities include: Disproportionate Share Hospitals that are publically owned and have a DSH percentage greater than 11.75% Children s Hospitals with Medicare DSH percentage greater than 11.75% Critical Access Hospitals Rural Referral Centers Sole Community Hospitals with Medicare DSH greater than 8% Federally Qualified Health Centers (FQHCs) Others So, a regular short-term acute hospital is not eligible for 340B unless it surpasses the special DSH threshold (11.75%). However, a non-340b hospital or hospital network may incorporate a special clinic that meets 340B criteria, and thus benefit from the program under certain guidelines. For example, 340B drugs may only be purchased for patients of the 340B Page 14

15 clinic. So the Parent Hospital or Network should establish separate purchasing accounts and dispensing records. 8.2 Recent Development and ACA Impact on 340B Programs. As mentioned earlier, the entire 340B enterprise is under a great deal of scrutiny today. Historically, the program relied on self-policing, and was perhaps subject to random audits by HRSA or by manufacturers. But the manufacturers are rejecting their role as subsidizers of the health care system. And Congress is re-visiting the original charter of 340B. That being, to help those organizations that serve the poor and underserved not necessarily to provide a revenue stream to health care providers. The Affordable Care Act (ACA) amended the 340B statute, requiring Health Resources and Services Administration (HRSA) to develop procedures that would require Covered Entities to regularly update information. In Spring 2012, HRSA began requiring Covered Entities to update information in HRSA s Covered Entity database and to recertify compliance with 340B program rules. 8.3 Conclusions and Recommendations. In this era of fiscal belt tightening, perhaps no other health care program will feel the screws tightening like 340B. For years, Congress looked at 340B as a way to help hospitals make ends meet, without tapping Federal or State budgets. But the drug companies have decided, enough is enough, and their lobby is sure to impact a Congress that already needs to find cuts in the Medicare budget. However, for at least the foreseeable future, there are several things 340B hospitals can do to protect their interests: Make sure to have a 340B compliance plan in place Maintain accurate records documenting compliance with program requirements. Covered Entities should have a complete audit trail from purchase to end user sale. In situations where outpatients receive 340B drugs and non-340b drugs, separate accounting systems need to be in place. Certainly, a 340B program can be an administrative nightmare. And many organizations are reluctant to enroll in 340B, and operate under this kind of intense oversight. If this were the only reason for NOT taking advantage of the opportunity, perhaps outsourcing the administrative/legal/compliance issues, would prove to be an acceptable recourse. And if you select a consult that works on a contingency basis, to manage your 340B program, you certainly don t risk losing revenue on the program. Quality Reimbursement Services, Inc. has been consulting hospitals on matters dealing with Medicare and Medicaid reimbursements since We work primarily on a contingency Page 15

16 basis, requiring no up-front or maintenance charges for our services. We would be happy to meet with you, and review your circumstances to see if we may be of service. Click here to: REQUEST ADDITIONAL INFORMATION FROM QRS 9 CAREERS 9.1 Equal Opportunity Statement It is the policy of Quality Reimbursement to afford full equal employment opportunity to qualified employees and applicants, regardless of their race, color, religion, sex, national origin, age, physical or mental handicaps, military or veteran status, sexual preference, or any other protected condition or characteristic in conformity with all applicable federal, state and local laws and regulations. 9.2 Currently Open Positions 9.3 At the moment there are no open positions Click here to: REQUEST ADDITIONAL INFORMATION FROM QRS 10 CONTACT US 10.1 QRS Locations Please click on location for contact details. Page 16

17 Corporate Office 150 N.Santa Anita Ave, Suite 570 A Arcadia, CA Tel: (626) Fax: (626) corporate@qualityreimbursement.com Birmingham, Alabama Contact Person: Mamie L. Mason th Ave. North Birmingham, AL Tel: (205) Fax: (205) mamie@qualityreimbursement.com Page 17

18 Scottsdale, Arizona Contact Person: Amrish Mathur N 137th Street Scottsdale, AZ Cell: (602) Fax: (480) acm.hss@gmail.com Los Angeles, California Contact Person: Daniel Silverberg 1800 Century Park East, Suite 600 Los Angeles, CA Tel: (310) Fax: (310) Daniel@qualityreimbursement.com Colorado Springs, Colorado Contact Person: Efren J. Junio 3790 D Strawberryfields Grove Colorado Springs, CO Tel: (719) Fax: (719) emj@qualityreimbursement.com Jacksonville, Florida Contact Person: Rick Buchanan 1326 Avondale Avenue Jacksonville, FL Page 18

19 Tel: (904) Fax: (904) Chicago, Illinois Contact Person: Christine Butterfield Marina Towers East 300 N State Street, #3232 Chicago, IL Office Tel: (312) Fax: (312) Corporate Telephone: (626) ext, 7412 Cell Telephone: (773) cbutterfield@qualityreimbursement.com Detroit, Michigan Contact Person: Niranjan J.(NJ) Thambythurai 1012 Seminole St. Detroit, MI Tel: (313) Fax: (313) nj@qualityreimbursement.com Contact Person: Brian Peterson 8139 Hedgeway Drive Shelby Township, MI Tel: (586) Fax: (206) bp@qualityreimbursement.com Page 19

20 Guttenberg, New Jersey Contact Person: Aruchunan (Vasee) Vaseekaran 7000 Boulevard E, Suite M3 Guttenberg, NJ Tel: (201) x111 Fax: (201) Spokane, Washington Contact Person: Delbert (Del) Nord 112 N.University Rd, Suite 308 Spokane Valley, WA Tel: (509) Tel: (509) Click here to: REQUEST ADDITIONAL INFORMATION FROM QRS Page 20