Rybar Group
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RGI News and Welcome

The Rybar Group is pleased to announce that Caren Puvalowski has joined us as a Critical Acces Hospital (CAH) Consultant on our Provider Payment Analytics team. More information on Caren to follow.


To learn more about how Caren may be able to assist your facility,  contact her directly at 810.853.6185 or via email at cpuvalowski@therybargroup.com.

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



Michigan CAH Conference – November 9-10

Caren Puvalowski Exhibiting

BDO Healthcare Webinar – December 13

Ron Rybar presenting on Healthcare Outlook 2018




Laura Lovett

Contributions by Laura Lovett CPC, CPCO, CPMA, CPC-I, CANPC, CEMC.  Laura can be reached directly at llovett@therybargroup.com or 810-853-6173

MACRA Participation is Voluntary…Sort of
MACRA (Medicare Access and CHIP Reauthorization Act) is the legislation that was introduced to replace the not sustainable SGR (Medicare Sustainable Growth Rate). It is said to be simpler than the current PQRS (Physician Quality Reporting System) but this remains to be seen and clearly shows the relativity of the word “simpler.” Read More

Mid‐level Provider Services
Coding and billing for mid‐level providers, NP/PAs, can seem like a daunting task. The reality is it is not
difficult if you take time to understand the guidelines and develop practices to utilize these providers
appropriately.  Read More

What it means to be a medical coder…….
You have to stop and think when someone asks you a question like “how old are you?” but can rattle off the codes for things like DM, HTN, COPD, GERD, etc. without batting an eye.
You find humor in the strangest things “this gentleman presents today after having accidentally introduced a foreign body into his left knee”. (FYI, he shot himself with a nail gun) Read More

Industry Trend: Probe Audits and Data Mining

Nobody wants to be audited. Nobody has time to be audited. Unfortunately that is the reality that
healthcare providers face; external audits can be initiated at any time. Read More