Rogers – Medicaid
In an effort to ensure that a behavioral health hospital was optimizing its rates with Federal and third-party payors, The Rybar Group provided an assessment of the facility’s previously filed and settled cost reports for the prior three fiscal years. Based on our recommendations and our work negotiating with Medicaid, the hospital has been able to recognize over $5M in reimbursement and additional revenue opportunities on a go forward basis.
Howard – Provider
The Rybar Group was contracted by a rural health system that owned a Critical Access Hospital (CAH). Our consultants identified additional home office services that were being provided to the CAH but the costs of those services were not being allocated to the CAH. The CAH realized over $200,000 per year in additional Medicare reimbursement. (CAH – Blessing)
Working on an accounting accuracy engagement for a University Hospital as part of their audit, The Rybar Group identified reimbursement opportunities up to $2M based on disallowable allied health and IME issues.
M&A – Buyer
An investment firm decided to expand into purchasing physician groups. They had already brokered the deal, deciding on the purchase price and agreeing to take on the practices liability among other concessions. Immediately prior to close, their accounting firm advised them to have a compliance audit of coding and documentation as a last tie up of loose ends. The Rybar Group was brought in to perform this audit, in which significant compliance risks along with inappropriate coding and billing practices were identified. The investment firm was able to renegotiate portions of the deal mitigating their risk going forward by not taking on the practices historic liability.
Principals at the firm indicated their regret in not doing the compliance audit prior to negotiating the deal. Having never purchased a healthcare practice before they were unaware of the complexities involved in validating the financial data reported by the practice is in fact valid and supported.
M&A – Seller
An investment firm was preparing to offer a physician group practice up for sale. Knowing the complexities of the industry and particular specialty, they brought in The Rybar Group to perform a due diligence audit of coding and billing prior to taking the practice to market. Though the firm had initially done an audit prior to purchasing the practice many years prior, there was no auditing or education performed after that until they decided to sell. Our consultants identified significant compliance risks along with inappropriate coding and billing practices. We assisted the practice in developing policies and procedures to correct the issues and performed a follow-up audit to ensure those procedures were implemented successfully. Once the practice became up-to-speed with compliance, coding, and billing requirements, the firm decided not to sell the practice.
By establishing a long-term relationship with a state health practice consortium through ongoing provider documentation reviews, The Rybar Group was able to not only assist the client with optimizing work flows for current services, but also assisted them with implementing new services for additional reimbursement such as chronic care management and telehealth services.
Through a compliance review, The Rybar Group identified services that were currently being provided to some patients that would allow for additional reimbursement. Because this was a service that was currently provided and compliantly documented, it caused minimal disruption for the client to begin billing for the service.
Performed an analysis for a Critical Access Hospital of converting several of their clinics to other provider types resulting in an over an additional $900,000 in reimbursements annually.
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