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Important Benefit for Medicare Dependent Hospitals and Sole Community Hospitals

The Volume Decrease Adjustment (VDA) is an important benefit to assist Medicare Dependent Hospitals (MDH) and Sole Community Hospitals (SCH) when they experience a decline in inpatient volume of greater than 5%. In order to receive the money, a written request must be submitted to the Medicare Administrative Contractor (MAC). The next question most providers will have is, “Then what?”

By regulation, the MAC is required to make a determination within 180 days of receiving the request and all other necessary information. Given this caveat, it is important to make sure that a provider anticipates all information a MAC will request and submit that upfront. However, it is difficult to anticipate with 100% certainty what information a MAC may request, or what parts of the request may require additional explanation.

For these reasons, it is important to periodically check in with the MAC. The Rybar Group typically follows up according to the following schedule:

  • Upon submission of the request, a confirmation of receipt is requested from the MAC. Weekly follow-ups are performed if no confirmation is received.
  • A 90-day follow-up to check in with the MAC, request an estimate of when the review will be completed, and see if any additional information is needed.
  • A follow-up either a) 90 days after responding to MAC requests for additional information, or b) around 150 days or 5 months after the request was submitted to make sure the MAC’s review is on schedule.

The Rybar Group has over 30 years of experience requesting VDAs, and we will manage all of the follow-up with your MAC to ensure you get the payment you deserve. Please contact Steve Sprague at ssprague@therybargroup.com, or 810-853-6169 today to discuss your unique situation.

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