Rybar Group
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Medicare HMO Reimbursement Impact on CAHs

As Medicare patients are moving from traditional coverage to a HMO product, it is important to ensure your contracts and payment model are moving appropriately as well.

With Medicare allowed cost based reimbursement to Critical Access Hospitals (CAHs), your Medicare HMO reimbursement needs to be reviewed to ensure you are receiving rates that are based on your facility’s costs.

Are you confident you are receiving all the reimbursement you are entitled to?

As a rural healthcare provider, you are an extremely important asset in your community. Specializing in CAH reimbursement, The Rybar Group will work to ensure that you are receiving appropriate Medicare HMO payments and that you have implemented a sound cost reimbursed strategy.

To further discuss what the transition can mean to you and your facility’s revenue, contact The Rybar Group today.

Rybar News

The Physician Services team at The Rybar Group has worked with some of the largest medical groups in the country and has helped to increase revenue and mitigate compliance risks, while optimizing operational effectiveness for clients.

With decades of diverse experience, we can assist with your biggest pain points within your organization and you’ll always have a senior associate working with you to tailor deliverables to fit your unique needs. The Rybar Group focuses on the financial aspect of healthcare and is able to support you with any initiative from documentation audits to preparing for a purchase or sale.

Here’s a sample of the services we offer to medical groups:

  • Provider compensation analysis
  • Coding and documentation audits and education
  • Payor negotiations
  • Project management
  • Specialty-specific practice assessments
  • Process improvement
  • Audits of external billing/coding companies
  • Litigation support
  • Compliance plan reviews
  • Fee schedule & chargemaster assessments

Contact Julie Hardy (jhardy@therybargroup.com or 810-853-6171) today to arrange for a FREE 10-chart audit to jump-start your improvement activities!

 Industry News and Updates

Are you unsure of what decreased uncompensated care costs mean to your entity?
Are you holding reserves for future re-distributions of pool payments or Upper Payment Limits?
If so we can help~
As the State works to collect the data necessary to calculate the 2014 Step II DSH pool payments and settle the 2014 cost reports, hospitals are left to account for estimates for over three years of potential redistributions and settlements.
As Uncompensated Care Costs decline redistributions of DSH payments are expected to increase. Also, as other supplemental pool payments increase and patients shift from Title XIX to HMP hospitals are left to account for multiple open settlement years.
If you have concerns of the impacts these items will have to your entity please reach out to us today.

Cash and Point-of-Service Collection Risks:
Although more Americans have health insurance coverage, 25% do not have money or liquid assets to cover their deductible, according to an article in U.S. Money on March 3, 2015. Even if your state has expanded Medicaid, according to the IRS regulation for 2016, HDHP individual policies have out-of-pocket maximums as high as $6,550 and family policies as high as $13,100.  HDHP are also required to have deductibles not less than $1,300 for an individual or $2,600 for a family.

Incident to vs. Split/Shared
There tends to be a lot of confusion surrounding services performed by mid-level providers, such as nurse practitioners and physician assistants….Read More


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