Third Party Reimbursement Solutions

Name

Third Party Reimbursement Solutions

Legal name

Third Party Reimbursement Solutions, LLC

Website

https://tprsolutions.com

Company type

Private

Founded year

2009

Operating status

Operating

Headcount range

11–50 employees

Ownership category

akta.pro rank

Product category

Healthcare Reimbursement Advisory Services

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)

SIC

Hospital & Medical Service Plans (6324), Services-Computer Programming, Data Processing, Etc. (7370)

akta.pro primary industry

Compliance, Reporting & Regulatory Administration (ERISA/ACA/No Surprises) (HLAEALAJ)

Keywords

• Healthcare reimbursement advisory
• Medicare Medicaid consulting
• Hospital cost report services
• Wage index optimization
• DSH reimbursement services

Headquarters

HQ city

Charlotte

HQ country

United States

HQ region

North America

Offices15 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Medicare/Medicaid Reimbursement Advisory Services: TPR provides comprehensive advisory services to hospitals and health systems focused on Medicare and Medicaid reimbursement regulatory issues. Services include cost report preparation, wage index reviews, DSH assessments, and regulatory compliance consulting.

Go-to-market motion2 records

Distribution channels1 record

Marketing channels3 records

Core offering

Third Party Reimbursement Solutions (TPR) is a full-service Medicare and Medicaid reimbursement advisory firm that delivers consulting services to hospitals and health systems. The company provides cost report preparation and review, wage index and occupational mix expertise, Medicare DSH and S-10 analysis, group appeals, MGCRB reclassifications, Medicare bad debts, Medicaid analysis and recoupment, medical education (IME/GME), co-sourcing/staffing, and operational strategy consulting including 340B eligibility and rural redesignations.

Product overview

Third Party Reimbursement Solutions (TPR) is a full-service Medicare and Medicaid reimbursement advisory firm that provides a comprehensive suite of consulting services rather than a unified software product. The company's core service portfolio spans cost report services (preparation, review, adjustments), appeals (group appeals, MGCRB reclassifications), specialized reimbursement areas (Medicare DSH & S-10, Medicare Bad Debts, Medicaid Analysis and Recoupment), and strategic consulting (wage index expertise, operational strategies, medical education). These services are delivered through 16 distinct offerings, including sub-services for rural redesignations, sole community hospital conversions, 340B eligibility, and merger & acquisition due diligence. TPR also provides co-sourcing services for staffing and regulatory support, and maintains a Resource Center with CMS Final Rules archives. The company leverages proprietary analytic algorithms and data mining techniques to turn healthcare data into actionable reimbursement insights.

Differentiator

Problem solved

Functional benefit

Products and services

• Wage Index & Occupational Mix Expertise Comprehensive wage index and occupational mix survey review services that help hospitals ensure compliant data filing, identify reimbursement opportunities, and navigate complex CMS rulings. For hospitals and health systems.
• Operational Strategies Strategic consulting services designed to empower healthcare facilities to capture reimbursement opportunities in compliant and efficient ways, addressing operational challenges and regulatory changes.
• Group Appeals Organized group appeals designed to optimize facility reimbursement outcomes, partnering with top healthcare attorneys to address crucial reimbursement issues.
• Co-Sourcing Services Strategic collaboration services that augment in-house capabilities with external regulatory expertise, including reimbursement department outsourcing, staffing, and comprehensive regulatory support.
• Medical Education Expertise in IME (Indirect Medical Education) and GME (Graduate Medical Education) reimbursement, including program setup, compliance tracking, and audit preparedness.
• Cost Report Services Medicare cost report preparation, review, and adjustment services including compilation, submission, executive summary analysis, appeal assistance, and PRRB position paper support.
• MGCRB Reclassifications Medicare Geographic Classification Review Board reclassification services including tailored strategies, regulatory advocacy, and complete handling from start to finish including appeals.
• Medicare DSH & S-10 Disproportionate Share Hospital and Uncompensated Care funding services leveraging advanced data processing to assess opportunities and ensure maximum reimbursement entitlements.
• Medicare Bad Debts Services to help hospitals identify, automate, and document Medicare-eligible bad debts, ensuring policies and procedures comply with MAC interpretation of allowable bad debts.
• Medicaid Analysis and Recoupment Comprehensive Medicaid cost report compliance and reimbursement services including settlement compilation, MAC audit support, response formulation, and appeal representation.

Quantifiable outcome

• Over $1 billion in additional reimbursement generated for clients through wage index and occupational mix projects
• +2 more outcomes

Named customers1 record

Segments1 record

Ideal customer profiles1 record

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability3 records

Feature4 records

Partnerships

Three partnerships are on record, tiered core and minor.

• Leading Healthcare AttorneyscoreImplementation/ SI/ Consulting PartnerTPR collaborates with leading healthcare attorneys to provide comprehensive reimbursement advocacy services. This partnership enables hospitals and health systems to address crucial reimbursement issues with legal expertise combined with reimbursement knowledge. TPR represents client interests during entrance and exit conferences and throughout the appeal process.
• Nationally Recognized Law FirmsminorImplementation/ SI/ Consulting PartnerTPR works with nationally recognized law firms on appeals and to help confirm that vague regulations are being interpreted appropriately for wage index and occupational mix services.
• Reimbursement Alliance Group, LLCcoreStrategic or Co-development PartnerMichael J. Polito serves as a Principal Member of the Reimbursement Alliance Group, LLC, indicating a strategic alliance relationship for providing reimbursement services.

Scale indicators5 records

Recent moves7 records

Expansion highlights5 records

Direct peers

• Forvis (formerly BKD CPAs & Advisors / Dixon Hughes Goodman): Top-10 U.S. accounting and advisory firm with a dedicated Healthcare Reimbursement practice serving hospitals and health systems on Medicare/Medicaid cost reports, DSH, wage index, and revenue cycle. Closest direct competitor to TPR with comparable service breadth and similar mid-sized firm positioning.
• Wipfli LLP: Top-20 U.S. accounting and consulting firm with a Healthcare Reimbursement practice providing cost report preparation, DSH, wage index, and revenue integrity services to hospitals. Directly comparable in service mix, client base, and firm size to TPR.
• Plante Moran: Major U.S. accounting and advisory firm with a healthcare practice serving hospitals and health systems on Medicare/Medicaid reimbursement, cost reports, and operational strategy. Comparable to TPR in service portfolio and hospital focus, with a larger firm footprint.
• HORNE LLP: Mid-sized U.S. accounting and advisory firm with a strong Healthcare Reimbursement specialty, including cost reports, DSH, wage index, and revenue cycle services for hospitals. Closely comparable specialty firm to TPR with a similar focus on hospital reimbursement optimization.
• Blue & Co., LLC: Mid-sized U.S. accounting and healthcare consulting firm providing reimbursement, cost report, DSH, and revenue cycle services to hospitals and health systems. Comparable in firm size, client base, and service specialization to TPR.
• Baker Tilly US, LLP: Top-10 U.S. accounting and advisory firm with a Healthcare Reimbursement practice serving hospitals on cost reports, DSH/S-10, wage index, and revenue cycle. Direct peer to TPR with broader firm resources and national reach.
• Eide Bailly LLP: Top-25 U.S. accounting and advisory firm with a healthcare practice that includes Medicare/Medicaid cost report preparation, DSH, wage index, and reimbursement consulting for hospitals. Comparable in service mix and client focus to TPR.

Broad incumbents

• CliftonLarsonAllen (CLA): Top-10 U.S. accounting and consulting firm with a healthcare practice serving hospitals and health systems on reimbursement, cost reports, and revenue cycle. Larger and broader incumbent competing for the same hospital reimbursement work as TPR.
• Moss Adams LLP: Top-15 U.S. accounting and consulting firm with a healthcare practice offering Medicare/Medicaid reimbursement, cost report, and revenue cycle services to hospitals. Larger incumbent peer with comparable service offerings.
• RSM US LLP: Top-5 U.S. accounting and consulting firm with a healthcare advisory practice serving hospitals and health systems on reimbursement, cost reports, and operational consulting. Broader incumbent competing for similar hospital advisory engagements as TPR.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/third-party-reimbursement-solutions-llc
• Xx.com/tprsolutions

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles25 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Third Party Reimbursement Solutions