Join our consultants as they present The Pitfalls of EMRs at upcoming SEHIMA conference.

EMRs are one of those things that make you go “hmm…, for even the best systems have pitfalls. Spend some time with us and learn how to identify the issues and ways to deal with them. A humorous approach to lessons learned in a variety of systems by various users. Who knew EMR’s could be so much fun!

SPEAKERS:   Laura Lovett, CPC, CPMA, CEMC - Consultant, Data Integrity and Compliance, The Rybar Group and Shawn Armbruster, RHIA -Manager, Data Integrity and Compliance, The Rybar Group

Conference Registration / Details:  The conference will be held August 19th, from 6–8 pm at Botsford Hospital. Contact Peggy Chapo for reservations:  / (248) 471-8180


Billing Michigan Uninsured ~ Are You Prepared?

Effective March 14, 2014, the maximum allowable payment for uninsured individuals is 115% of Medicare rates when the person has an annual income level up to 250% of the federal poverty guidelines. This is based on the requirements of Public Act 107 of 2013 (also known as the Healthy Michigan Plan that expanded Medicaid).

Although in Michigan we expect about 100,000 individuals to qualify for expanded Medicaid, and others should purchase insurance, history tells us that many patients will seek healthcare who still do not have insurance. 

This requirement will have numerous implications on your processes, policies and systems. Changes include the need to check the income level of an individual who is uninsured to verify that they do not qualify and developing new discount policies, to name a few. Activity is needed now to ensure that you are prepared to handle this mandate.

A copy of PA 107 can be found at: Language related to the limited maximum payment can be found on page 3.

For additional information on the regulation, how it may impact your facility, and steps that you can take to prepare for the change, please contact:

Claudia Birkenshaw Garabelli, MSA                         



Lynn Pepper, CRCE-I



NUBC Revises Occurrence Code 72 to Accommodate Two-Midnight Provision for both IPPS and CAH Facilities


The National Uniform Billing Committee has redefined a code in its billing data set (Occurrence Code 72) to allow hospitals to denote inpatient claims meeting CMS’ two-midnight benchmark through a combination of outpatient and inpatient services.


Effective December 1, 2013, hospitals may use Occurrence Code 72 on inpatient bills to denote the date span of contiguous outpatient hospital services that preceded the inpatient admission.


CMS is developing a Change Request (CR 8586) and a MedLearn Matters, which should be published within the next few weeks and will include examples. 


The goal of the revised code is to prevent the claim from being auditing.  Below are unofficial examples of when a hospital may consider using occurrence space code 72.


 Example 1:


  • Beneficiary is in outpatient observation 12/1/2013—12/2/2013.

  • Beneficiary is admitted as an inpatient on 12/2/2013.

  • Beneficiary is discharged on 12/3/2013.

  • Total time in the hospital meets the 2 midnight benchmark.


 Example 2:


  • Beneficiary is in outpatient Emergency Department 12/11/2013—12/12/2013.

  • Beneficiary is admitted as an inpatient on 12/12/2013.

  • Beneficiary is discharged on 12/13/2013.

  • Total time in the hospital meets the 2 midnight benchmark.


 Example 3:


  • Beneficiary is in outpatient Surgical Encounter 12/11/2013—12/12/2013.

  • Beneficiary is admitted as an inpatient on 12/12/2013.

  • Beneficiary is discharged on 12/13/2013.

  • Total time in the hospital meets the 2 midnight benchmark.

If you have questions, call or email Claudia Birkenshaw Garabelli or Lynn Pepper at 810-750-6822.

View link for more information from the NUBC website.

In the recent weeks, several regulatory changes have been announced that can have a direct impact on your facility’s revenue cycle. Some of the key changes include:


The Rybar Group is committed to providing Sole Community (SCH) and Medicare Dependent (MDH)
Hospitals with up to date information on regulatory changes and industry news.
Recently, we have created the Rural Hospital Reimbursement Linkedin group
, designed to provide its
members the latest information important to SCH and MDH providers
, as well as offer a forum for
other providers to discuss challenges their facility may face. 

Please join our Rural Hospital Reimbursement Linkedin group to connect with other Rural Hospitals, such as yourself.


CLICK HERE TO JOIN - Rural Hospital Reimbursement Linkedin Group

Medicare DSH/SSI Rates

Recently, CMS published the long-awaited SSI rates for use when computing Medicare DSH payments for FYs 2006, 2007, 2008 and 2009. What this means for providers is that a flood of NPR dates are being released for open cost reports, dating back to FY 2007 and earlier. Some providers have waited nearly four years for this NPR.

Now is the time to look at your Low Volume/Volume Decrease Payment Adjustments opportunities for the years that qualify to ensure that accurate documentation is submitted within the 180 day deadline from receiving your NPR.

Our consultants are available to assist you in submitting this request for additional Medicare reimbursement.

Contact us today to discuss your opportunities.