S-10 Uncompensated Care. Medicare DSH Reimbursement. 340B/GPO Optimization.

 

About Us


Southwest Consulting Associates (SCA) was founded in 1989 to provide financial consulting services to healthcare providers. Since its founding, SCA has steadily built its practice into the nation’s leading Medicare Disproportionate Share (DSH) reimbursement assurance program with over 400 clients in 41 states. SCA’s services continue to evolve with ever changing hospital payment systems and the compliance landscape associated with Medicare DSH, Medicaid DSH, the 340B drug pricing program, uncompensated care funding under the Affordable Care Act (ACA) and other hospital payment system changes.

SCA has long been at the forefront in providing consulting support to hospitals pursuing Medicare reimbursement via litigation at the Provider Reimbursement Review Board (PRRB) and in federal court. We support providers through the reimbursement legal process by producing the necessary detailed support required for hospital client appeals, analyzing agency data in support of the legal arguments being advanced, working with attorneys to prepare court filings and presenting testimony before the PRRB. SCA was on the frontline of the following landmark reimbursement decisions.

  • “97-2 Monmouth”: CMS settled with plaintiff hospitals for a total of $667,000,000 with SCA developing the modeling system to implement the settlement for over 2,600 fiscal years. (Baystate Medical Center v. Leavitt, 545 F. Supp. 2d 20, amended, 587 F. Supp. 2d 37 (D.D.C. 2008)
  • Baystate SSI: after thirteen-years CMS acquiesced to paying hospitals pursuant to a revised methodology detailed in CMS Ruling 1498-R. (Baystate Medical Center v. Leavitt, 545 F. Supp. 2d 20, amended, 587 F. Supp. 2d 37 (D.D.C. 2008))
  • Northeast Hospital Corporation (d/b/a Beverly Hospital): D.C District Court ruled favorably on the SSI, Labor & Delivery Room and Medicare+Choice (now Medicare Advantage) issues. (Northeast Hospital Corporation v. Sebelius, 699 F. Supp. 2d 81 (D.D.C 2010))

The professional team at SCA strives to meet the needs of our clients in an ever changing environment by providing as-filed cost report service, audit support, regulatory analysis, implementation support and compliance services in a proactive and collaborative manner. Over the last 25 years, hundreds of hospitals have chosen SCA to provide consulting services in the healthcare finance and compliance arenas. The SCA team continues to develop reimbursement solutions to service the healthcare provider community.