Summary & Examples:

The FMAP for each state defines the percentage shares of federal and state funding for Medicaid payments associated with a particular federal fiscal year (October 1 – September 30). If FMAP is 0.60 the federal share of a Medicaid payment will be 60%, and the state share will be 40%. In other words, in order to obtain federal Medicaid assistance, the state must contribute 40 cents of each Medicaid dollar paid to a service provider. If FMAP is 0.60, and the state contributes $1 toward a Medicaid payment, the federal share will be $1.50, for a total payment of $2.50. Thus the state receives a return on this dollar of 150% or a multiple of 1.5–sometimes referred to as the multiplier.

State Medicaid Funding:

The state portion of Medicaid payments is assumed by the federal authorities to be based on state and/or local government revenues. Routine Medicaid payments typically are funded through state legislative appropriations, as are some supplemental payments. However, many states fund part of their Medicaid programs through local governmental entities such as cities, counties, hospital districts, and Local Provider Participation Funds (LPPFs). In such cases, the “state” portion of the Medicaid payment is sent to the state from the local entity by means of an on-line Inter- Governmental Transfer (IGT).

The Basic Formulas Revisited:

MEDICAID PAYMENT = STATE $ / (1 – FMAP)

  • Example: At FMAP = .60, a state share of $1,000,000 would support a total Medicaid payment of $1,000,000 / (1 – .60) = $1,000,000 / .40 = $2,500,000

THE MULTIPLIER = FMAP / (1 – FMAP)

  • At FMAP = .60, the multiplier is .60 / (1 – .60) = .60 / .40 = 1.5. Thus a state contribution of $1,000,000 would generate a federal contribution of $1,000,000 * 1.5 = $1,500,000.

REQUIRED STATE $ = MEDICAID PAYMENT * (1 – FMAP)

  • At FMAP = .60, a Medicaid payment of $1,000,000 would require a state share of $1,000,000 x (1 – .60) = $1,000,000 x .40 = $400,000.

CALCULATOR TERMINOLOGY

  • “Net” refers to the payment amount that is the federal share only (sometimes referred to as the “fed match”)
  • “Gross” refers to the entire payment amount that includes both federal and state shares
NET $ {{ net_match }}
GROSS $ {{ gross_match }}

Select one of the following:

Medicaid Payment = State $ / (1 - FMAP)
Required State $ = Medicaid Payment * (1 - FMAP)
Explained: State Medicaid Funding
clear

Last Modified: September 13, 2016

ACCEPTANCE OF THE TERMS OF USE

Welcome to the website of Adelanto HealthCare Ventures, L.L.C. (“Company”, “we” or “us”). The following terms and conditions, together with any documents they expressly incorporate by reference (collectively, these “Terms of Use”), govern your access to and use of www.ahcv.com, including any content, functionality and services offered on or through www.ahcv.com (the “Website”).

Please read the Terms of Use carefully before you start to use the Website. By using the Website, you accept and agree to be bound and abide by these Terms of Use. If you do not want to agree to these Terms of Use, you must not access or use the Website.

This Website is offered and available to users who are 18 years of age or older and reside in the United States or any of its territories. By using this Website, you represent and warrant that you meet all of the foregoing eligibility requirements. If you do not meet all of these requirements, you must not access or use the Website.

CHANGES TO THE TERMS OF USE

We may revise and update these Terms of Use from time to time in our sole discretion. All changes are effective immediately when we post them, and apply to all access to and use of the Website thereafter. However, any changes to dispute resolution provisions set forth in Governing Law and Jurisdiction will not apply to any disputes for which the parties have actual notice on or prior to the date the change is posted on the Website.

Your continued use of the Website following the posting of revised Terms of Use means that you accept and agree to the changes. You are expected to check this page each time you access this Website, so you are aware of any changes, as they are binding on you.

ACCESSING THE WEBSITE

We reserve the right to withdraw or amend this Website, and any service or material we provide on the Website, in our sole discretion without notice. We will not be liable if for any reason all or any part of the Website is unavailable at any time or for any period. From time to time, we may restrict access to some parts of the Website, or the entire Website, to users, including registered users.

YOU ARE RESPONSIBLE FOR:

  • Making all arrangements necessary for you to have access to the Website.
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  • Intellectual Property Rights
  • The Website and its entire contents, features and functionality (including but not limited to all information, software, text, displays, images, video and audio, and the design, selection and arrangement thereof), are owned by the Company, its licensors or other providers of such material and are protected by United States and international copyright, trademark, patent, trade secret and other intellectual property or proprietary rights laws.
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  • If we provide desktop, mobile or other applications for download, you may download a single copy to your computer or mobile device solely for your own personal use, provided you agree to be bound by our end user license agreement for such applications.

You must not:

  • Modify copies of any materials from this Website.
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  • If you print, copy, modify, download or otherwise use or provide any other person with access to any part of the Website in breach of the Terms of Use, your right to use the Website will cease immediately and you must, at our option, return or destroy any copies of the materials you have made. No right, title or interest in or to the Website or any content on the Website is transferred to you, and all rights not expressly granted are reserved by the Company. Any use of the Website not expressly permitted by these Terms of Use is a breach of these Terms of Use and may violate copyright, trademark and other laws.

TRADEMARKS

The Company name, the Company logo, and all related names, logos, product and service names, designs and slogans are trademarks of the Company or its affiliates or licensors. You must not use such marks without the prior written permission of the Company. All other names, logos, product and service names, designs and slogans on this Website are the trademarks of their respective owners.

PROHIBITED USES

You may use the Website only for lawful purposes and in accordance with these Terms of Use. You agree not to use the Website:

  • In any way that violates any applicable federal, state, local or international law or regulation (including, without limitation, any laws regarding the export of data or software to and from the US or other countries).
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  • To engage in any other conduct that restricts or inhibits anyone’s use or enjoyment of the Website, or which, as determined by us, may harm the Company or users of the Website or expose them to liability.

Additionally, you agree not to:

  • Use the Website in any manner that could disable, overburden, damage, or impair the Website or interfere with any other party’s use of the Website, including their ability to engage in real time activities through the Website.
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  • Otherwise attempt to interfere with the proper working of the Website.
  • Monitoring and Enforcement; Termination

We have the right to:

  • Disclose your identity or other information about you to any third party who claims that material posted by you violates their rights, including their intellectual property rights or their right to privacy.
  • Take appropriate legal action, including without limitation, referral to law enforcement, for any illegal or unauthorized use of the Website.
  • Terminate or suspend your access to all or part of the Website for any or no reason, including without limitation, any violation of these Terms of Use.
  • Without limiting the foregoing, we have the right to fully cooperate with any law enforcement authorities or court order requesting or directing us to disclose the identity or other information of anyone posting any materials on or through the Website. YOU WAIVE AND HOLD HARMLESS THE COMPANY AND ITS AFFILIATES, LICENSEES AND SERVICE PROVIDERS FROM ANY CLAIMS RESULTING FROM ANY ACTION TAKEN BY ANY OF THE FOREGOING PARTIES DURING OR AS A RESULT OF ITS INVESTIGATIONS AND FROM ANY ACTIONS TAKEN AS A CONSEQUENCE OF INVESTIGATIONS BY EITHER SUCH PARTIES OR LAW ENFORCEMENT AUTHORITIES.
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RELIANCE ON INFORMATION POSTED

The information and features presented on or through the Website are made available solely for general information purposes. We do not warrant the accuracy, completeness or usefulness of this information. Any reliance you place on such information is strictly at your own risk. We disclaim all liability and responsibility arising from any reliance placed on such materials by you or any other visitor to the Website, or by anyone who may be informed of any of its contents.

NO LEGAL OR ACCOUNTING ADVICE

Company provides consulting services for healthcare providers. Company does not provide legal services or accounting services. The information and materials on this Website are made available by Company for informational purposes only. Neither Company’s services, nor the information on this Website, should be construed as legal advice. Company strongly encourages customers to retain legal counsel to address any legal questions that may arise.

ENGAGING COMPANY FOR CONSULTATION SERVICES

This Website does not create, a confidential relationship between you and AHCV, nor is it intended to do so. Please do not act or rely on any information in this Website. Additionally, please do not send us, via e-mail or otherwise, any confidential information unless or until we have entered into an Engagement Letter in which we agree to perform services for you.

Each project we work on presents challenges that are is different and unique. Success in past projects does not guarantee success on future projects. Success depends on the individual facts related to each project.

THIRD-PARTY CONTENT

This Website includes content provided by third parties, including materials provided by other users, bloggers and third-party licensors, syndicators, aggregators and/or reporting services. All statements and/or opinions expressed in these materials, and all articles and responses to questions and other content, other than the content provided by the Company, are solely the opinions and the responsibility of the person or entity providing those materials. These materials do not necessarily reflect the opinion of the Company. We are not responsible, or liable to you or any third party, for the content or accuracy of any materials provided by any third parties.

CHANGES TO THE WEBSITE

We may update the content on this Website from time to time, but its content is not necessarily complete or up-to-date. Any of the material on the Website may be out of date at any given time, and we are under no obligation to update such material.

LINKING TO THE WEBSITE AND SOCIAL MEDIA FEATURES

You may link to our homepage, provided you do so in a way that is fair and legal and does not damage our reputation or take advantage of it, but you must not establish a link in such a way as to suggest any form of association, approval or endorsement on our part without our express written consent.

This Website may provide certain social media features that enable you to:

  • Link from your own or certain third-party websites to certain content on this Website.
  • Send e-mails or other communications with certain content, or links to certain content, on this Website.
  • Cause limited portions of content on this Website to be displayed or appear to be displayed on your own or certain third-party websites.
  • You may use these features solely as they are provided by us, solely with respect to the content they are displayed with, and otherwise in accordance with any additional terms and conditions we provide with respect to such features. Subject to the foregoing, you must not:
  • Establish a link from any website that is not owned by you.
  • Cause the Website or portions of it to be displayed, or appear to be displayed by, for example, framing, deep linking or in-line linking, on any other site.
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  • Otherwise take any action with respect to the materials on this Website that is inconsistent with any other provision of these Terms of Use.
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  • We may disable all or any social media features and any links at any time without notice in our discretion.

LINKS FROM THE WEBSITE

If the Website contains links to other sites or resources provided by third parties (collectively, “Third-Party Resources”), these links are provided for your convenience only. This includes links contained in advertisements, including banner advertisements and sponsored links. We have no control over the contents of Third-Party Resources, and accept no responsibility for them or for any loss or damage that may arise from your use of them. If you decide to access any Third-Party Resource linked to this Website, you do so entirely at your own risk and subject to the terms and conditions of use for such Third-Party Resource.

GEOGRAPHIC RESTRICTIONS

The owner of the Website is based in the state of Texas in the United States. We provide this Website for use only by persons located in the United States. We make no claims that the Website or any of its content is accessible or appropriate outside of the United States. Access to the Website may not be legal by certain persons or in certain countries. If you access the Website from outside the United States, you do so on your own initiative and are responsible for compliance with local laws.

DISCLAIMER OF WARRANTIES

You understand that we cannot and do not guarantee or warrant that files available for downloading from the internet or the Website will be free of viruses or other destructive code. You are responsible for implementing sufficient procedures and checkpoints to satisfy your particular requirements for anti-virus protection and accuracy of data input and output, and for maintaining a means external to our Website for any reconstruction of any lost data. WE WILL NOT BE LIABLE FOR ANY LOSS OR DAMAGE CAUSED BY A DISTRIBUTED DENIAL-OF-SERVICE ATTACK, VIRUSES OR OTHER TECHNOLOGICALLY HARMFUL MATERIAL THAT MAY INFECT YOUR COMPUTER EQUIPMENT, COMPUTER PROGRAMS, DATA OR OTHER PROPRIETARY MATERIAL DUE TO YOUR USE OF THE WEBSITE OR ANY SERVICES OR ITEMS OBTAINED THROUGH THE WEBSITE OR TO YOUR DOWNLOADING OF ANY MATERIAL POSTED ON IT, OR ON ANY WEBSITE LINKED TO IT.

YOUR USE OF THE WEBSITE, ITS CONTENT AND ANY SERVICES OR ITEMS OBTAINED THROUGH THE WEBSITE IS AT YOUR OWN RISK. THESE ITEMS ARE FOR INFORMATIONAL PURPOSES ONLY AND SHOULD NOT BE RELIED UPON BY ANYONE. THE WEBSITE, ITS CONTENT AND ANY SERVICES OR ITEMS OBTAINED THROUGH THE WEBSITE ARE PROVIDED ON AN “AS IS” AND “AS AVAILABLE” BASIS, WITHOUT ANY WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED. NEITHER THE COMPANY NOR ANY PERSON ASSOCIATED WITH THE COMPANY MAKES ANY WARRANTY OR REPRESENTATION WITH RESPECT TO THE COMPLETENESS, SECURITY, RELIABILITY, QUALITY, ACCURACY OR AVAILABILITY OF THE WEBSITE. WITHOUT LIMITING THE FOREGOING, NEITHER THE COMPANY NOR ANYONE ASSOCIATED WITH THE COMPANY REPRESENTS OR WARRANTS THAT THE WEBSITE, ITS CONTENT OR ANY SERVICES OR ITEMS OBTAINED THROUGH THE WEBSITE WILL BE ACCURATE, RELIABLE, ERROR-FREE OR UNINTERRUPTED, THAT DEFECTS WILL BE CORRECTED, THAT OUR WEBSITE OR THE SERVER THAT MAKES IT AVAILABLE ARE FREE OF VIRUSES OR OTHER HARMFUL COMPONENTS OR THAT THE WEBSITE OR ANY SERVICES OR ITEMS OBTAINED THROUGH THE WEBSITE WILL OTHERWISE MEET YOUR NEEDS OR EXPECTATIONS.

THE COMPANY HEREBY DISCLAIMS ALL WARRANTIES OF ANY KIND, WHETHER EXPRESS OR IMPLIED, STATUTORY OR OTHERWISE, INCLUDING BUT NOT LIMITED TO ANY WARRANTIES OF MERCHANTABILITY, NON-INFRINGEMENT AND FITNESS FOR PARTICULAR PURPOSE.

THE FOREGOING DOES NOT AFFECT ANY WARRANTIES WHICH CANNOT BE EXCLUDED OR LIMITED UNDER APPLICABLE LAW.

LIMITATION ON LIABILITY

IN NO EVENT WILL THE COMPANY, ITS AFFILIATES OR THEIR LICENSORS, SERVICE PROVIDERS, EMPLOYEES, MEMBERS, MANAGERS, AGENTS, OFFICERS OR DIRECTORS BE LIABLE FOR DAMAGES OF ANY KIND, UNDER ANY LEGAL THEORY, ARISING OUT OF OR IN CONNECTION WITH YOUR USE, OR INABILITY TO USE, THE WEBSITE, ANY THIRD-PARTY RESOURCE, ANY CONTENT OR FEATURES ON THE WEBSITE OR SUCH THIRD-PARTY RESOURCE OR ANY SERVICES OR ITEMS OBTAINED THROUGH THE WEBSITE OR SUCH THIRD-PARTY RESOURCE, INCLUDING BUT NOT LIMITED TO ANY DIRECT, INDIRECT, SPECIAL, INCIDENTAL, CONSEQUENTIAL OR PUNITIVE DAMAGES, INCLUDING BUT NOT LIMITED TO, PERSONAL INJURY, PAIN AND SUFFERING, EMOTIONAL DISTRESS, LOSS OF REVENUE, LOSS OF PROFITS, LOSS OF BUSINESS OR ANTICIPATED SAVINGS, LOSS OF USE, LOSS OF GOODWILL, LOSS OF DATA, AND WHETHER CAUSED BY TORT (INCLUDING NEGLIGENCE), BREACH OF CONTRACT OR OTHERWISE, EVEN IF FORESEEABLE.

THE FOREGOING DOES NOT AFFECT ANY LIABILITY WHICH CANNOT BE EXCLUDED OR LIMITED UNDER APPLICABLE LAW.

INDEMNIFICATION

You agree to defend, indemnify and hold harmless the Company, its affiliates, licensors and service providers, and its and their respective officers, directors, members, managers, employees, contractors, agents, licensors, suppliers, successors and assigns from and against any claims, liabilities, damages, judgments, awards, losses, costs, expenses or fees (including reasonable attorneys’ fees) arising out of or relating to your violation of these Terms of Use or your use of the Website, including, but not limited to, any use of the Website’s content, services and features other than as expressly authorized in these Terms of Use or your use of any information obtained from the Website.

GOVERNING LAW AND JURISDICTION

All matters relating to the Website and these Terms of Use and any dispute or claim arising therefrom or related thereto (in each case, including non-contractual disputes or claims), shall be governed by and construed in accordance with the internal laws of the State of Texas without giving effect to any choice or conflict of law provision or rule (whether of the State of Texas or any other jurisdiction).

Any legal suit, action or proceeding arising out of, or related to, these Terms of Use or the Website shall be instituted exclusively in the federal courts of the United States or the courts of the State of Texas in each case located in the City of Austin and County of Travis, although we retain the right to bring any suit, action or proceeding against you for breach of these Terms of Use in your country of residence or any other relevant country. You waive any and all objections to the exercise of jurisdiction over you by such courts and to venue in such courts.

LIMITATION ON TIME TO FILE CLAIMS

ANY CAUSE OF ACTION OR CLAIM YOU MAY HAVE ARISING OUT OF OR RELATING TO THESE TERMS OF USE OR THE WEBSITE MUST BE COMMENCED WITHIN ONE (1) YEAR AFTER THE CAUSE OF ACTION ACCRUES, OTHERWISE, SUCH CAUSE OF ACTION OR CLAIM IS PERMANENTLY BARRED.

WAIVER AND SEVERABILITY

No waiver by the Company of any term or condition set forth in these Terms of Use shall be deemed a further or continuing waiver of such term or condition or a waiver of any other term or condition, and any failure of the Company to assert a right or provision under these Terms of Use shall not constitute a waiver of such right or provision.

If any provision of these Terms of Use is held by a court or other tribunal of competent jurisdiction to be invalid, illegal or unenforceable for any reason, such provision shall be eliminated or limited to the minimum extent such that the remaining provisions of the Terms of Use will continue in full force and effect.

ENTIRE AGREEMENT

The Terms of Use constitute the sole and entire agreement between you and Company with respect to the Website and supersede all prior and contemporaneous understandings, agreements, representations and warranties, both written and oral, with respect to the Website.

YOUR COMMENTS AND CONCERNS

This website is operated by Adelanto HealthCare Ventures, L.L.C., 401 W. 15th Street, Suite 840, Austin, Texas 78701-4078

All other feedback, comments, requests for technical support and other communications relating to the Website should be directed to: info@ahcv.com.

Thank you for visiting the Website.

Mission & Vision

MISSION | INNOVATIVE SOLUTIONS FOR HEALTHCARE PROVIDERS

The mission of AHCV is to generate innovative solutions that enhance the ability of healthcare providers to serve patients and the communities in which they live.

Our solutions focus on improving not only the health of patients, but also healthcare services in their communities at large. As a leader in the healthcare consulting industry, our responsibility is to emphasize public health and patient service to the providers with whom we work. We develop transparent, compliant, and ethical solutions that strengthen the safety-net system while balancing the need to control costs. It is our duty and our obligation to serve our clients by meeting their goals while always focusing on the overall benefit to the community.

VISION | EXPANDING SERVICES AND INCREASING EFFICIENCY FOR HEALTHCARE

Our vision at AHCV is to build a stronger safety-net system for communities across the country.

To accomplish this the AHCV Team uses its full scope of resources to identify innovative solutions for healthcare providers. By continuously innovating the healthcare reimbursement system, we believe that we will expand services and increase efficiency for the healthcare network.

About Us

The AHCV Team is a network of business consultants that includes former high-ranking officials at state Medicaid agencies, lawyers who helped healthcare providers complete complex business transactions, and former high-ranking executives at public and private healthcare institutions. Our cross-functional team of expert consultants has the experience your entity needs to boost revenue, identify solutions to complex risks, and increase financial efficiency.

Specializing in Medicaid, our job is to ensure that healthcare providers receive their fair share of reimbursement for the services they provide. Whether it is designing a patient-centered service expansion initiative or conducting a detailed data-mining analysis, the AHCV Team ensures that your entity is tracking data accurately, efficiently, and, most important, within compliance.

While improving financial efficiency for healthcare providers, AHCV prioritizes expanding healthcare services for patients who typically are underserved. We help providers meet this challenge while balancing the need to manage increasing costs. Consistent with this, AHCV makes charitable donations to organizations that are committed to helping underserved patients.

Services We Provide

AHCV’s highly acclaimed team of consultants specializes in healthcare transactional advisory support, reimbursement analysis, and revenue cycle. Our professionals have the domain expertise and skills to assist organizations with the numerous types of analyses and support to enable effective strategic decision making. AHCV’s data-driven approach provides our clients with the tools necessary to make strong strategic decisions.

TRANSACTIONAL ADVISORY SUPPORT

Healthcare Due Diligence Support Services

  • Provide Standardize Due Diligence Information Request
  • Assist with aggregation of requested due diligence information
  • Preparation of Due Diligence Disclosure Report

Review of Patient Net Revenue

  • Validate accuracy and appropriateness of patient net revenue and patient Accounts Receivable balances presented on financial statements.
  • Review of patient net revenue impacts related to governmental programs such as Medicare and Medicaid.
  • Identify trends related to key drivers of patient net revenue.
  • Identify patient net revenue opportunities and/or patient net revenue risk areas, and quantification of amounts related thereto.

HOSPITAL ADVISORY SERVICES RELATED TO PROVIDER TAXES & IGT

  • Establish a framework for enhanced Medicaid managed care rate initiative funded by intergovernmental transfers (“IGT”).
  • Monitor provider tax programs. Advise participating clients concerning regulatory risks and changes, and aid in responding to governmental inquiries related to the state and/or federal supplemental payment programs.
  • Development of tools tailored specifically to assist facilities in understanding projected reimbursement opportunities and monitor cash flow.
  • Assess additional related opportunities to reduce reimbursement risk.

MEDICAL TRANSPORTATION CONSULTING

  • Evaluate regulatory structure for non-emergent medical transportation services.
  • Prepare Financial modeling of Medicaid reimbursement for covered services.

REIMBURSEMENT ANALYSIS

Managed Care Impact Analyses (“Black Box”)

Managed Care Rate Analytics and Negotiations

  • In-network vs. Out-of-network market analysis
  • Representation concerning access, network inclusion and exclusion, covered services, rate discrepancies, and the delinquent, non-payment, or underpayment of claims

REVENUE CYCLE OPTIMIZATION

  • Revenue Cycle Assessment
  • Future-state design and process optimization
  • Performance improvement planning and support
  • Strategic Pricing
  • Healthcare Net Revenue Reporting

SUPPLEMENTAL PAYMENT PROGRAMS

  • Disproportionate Share Hospital (“DSH”) Payments
  • Upper Payment Limit (“UPL”) Payments
  • Graduate Medical Education (“GME”) Payments
  • Uncompensated Care (“UC”) Payments
  • Delivery System Reform Incentive Payments (“DSRIP”)

REGULATORY ANALYSIS

  • Provide knowledgeable and efficient strategic advice to participants in various sectors of the dynamic, heavily regulated healthcare industry.
  • Consult on Medicare and Medicaid reimbursement and payment rules, conditions of participation, licensure and certification, prompt payment, and legislative and rule making initiatives.
  • Identify regulatory and compliance issues and advise on the implementation of strategies and solutions to address compliance concerns, including those arising with respect to fraud and abuse, reimbursement, and health information privacy/security.

Get In Touch

 512.322.9413
 info@ahcv.com

OUR OFFICE LOCATIONS

Austin, TX

401 W 15th Street, Suite 840
Austin, TX 78701

Washington, DC

1155 Connecticut Ave NW, 4th floor
Washington, DC 20036

Laredo, TX

1407 Washington Street
Laredo, TX 78042

Nashville, TN

475 Saundersville Road, Suite 150
Hendersonville, TN 37075