Third Party Reimbursement Solutions, LLC (“TPR”) was formed in April of 2008 by Michael Polito.
TPR has evolved into a national consulting firm and provides full service Medicare and Medicaid reimbursement services. The cornerstone of our growth and success lies within the strategic hiring of high level and experienced regulatory personnel in addition to employing a robust data and technology department.
Prior to creating TPR Michael served as a Healthcare Director out of the Charlotte, North Carolina office at PricewaterhouseCoopers, LLP (“PwC”). Mr. Polito’s experience includes eleven total years at PwC, at which time he focused on Hospital regulatory payment issues, client service and product / business development.
While with PwC, Mr. Polito directed the preparation and analysis of numerous cost reports for a wide range of facilities, including acute care hospitals, home office, rural health clinics, home health agencies and outpatient rehab facilities. Mr. Polito also reviewed financial statement estimates, contractual reserve adjustments, and performed due diligence services for a wide variety of clients. Mr. Polito successfully developed a Medicare wage index assessment program, and a methodology to identify Medicaid eligibility days for inclusion in the Medicare disproportionate share calculation both of which have been adopted by PwC on a national level.
Mr. Polito has directly managed in excess of 250 disproportionate share engagements that have generated over $170 million in additional reimbursement for his clients. In addition, Mr. Polito has been directly responsible for the delivery of over 450 Medicare wage index projects which has generated in excess of $145.0 million of revenue for his clients.
Prior to joining PwC, Mr. Polito worked for Blue Cross of Northeastern Pennsylvania in the Provider Audit department (four years). His role within the Fiscal Intermediary involved the audit of, bond issues, financing agreements, bad debts, Medicare DSH payments, wage index data, medical education programs, and the interpretation of Medicare regulations to ensure the fair presentation of the Medicare cost report.
Mr. Polito has been involved with a Medicare and Medicaid federal fraud investigation and a Department of Justice False Claims investigation. As part of the investigations, he worked closely with the defense team, the U.S. Attorney's Office, and the Department of Justice. Mr. Polito has also testified as an expert witness on Medicare reimbursement principles at the Provider Reimbursement Review Board.