The foundation of expertise and creative innovation at The Rybar Group begins with our people. Multidisciplinary in composition, they collectively hold over 150 years of hands-on management in the healthcare financial, revenue cycle, compliance, provider and payor experience.
RONALD K. RYBAR, FHFMA, CMPA
As the Founder and President of The Rybar Group, Ron offers over forty years of experience in healthcare financial management to our clients. Ron began his career working in the Finance department of various Michigan hospitals, before becoming a consultant with a national public accounting firm, focusing on healthcare clients. He formed The Rybar Group in 1989 with the mission to provide quality service to healthcare management, while assisting them in maintaining financial viability through compliant, efficient business operations. He has spent the past thirty years leading The Rybar Group in becoming a nationally recognized premier healthcare consulting firm.
Over the years, Ron has worked with providers nationwide on engagements related to financial performance, revenue integrity, payment optimization and compliance with federal and third-party payor regulations. Ron’s successes include:
- Successfully negotiated with Medicare and Blue Cross Blue Shield on payment and appeal issues.
- Recognized successful outcomes on numerous PRRB hearings.
- Completed numerous successful Medicare appeals and Sole Community and Medicare Dependent Hospital Volume Decrease Payment Adjustment exception requests.
- Negotiated PPO and managed care arrangements on behalf of hospitals.
- Directed several revenue integrity studies.
- Negotiated in joint-venture situations.
- Provided litigation support for a variety of providers and provided testimony in Federal District Court as an expert witness.
Additional achievements and activities include numerous Interim Chief Financial Officer engagements, cost report strategies, reimbursement and revenue estimating studies for hospitals, home health agencies, hospices and SNFs, and the completion of numerous strategic pricing analyses and feasibility studies for health-related facilities. He has assisted in corporate reorganization, establishment and setup of new corporate entities, and provided financial training for corporate board members.
In addition to his activities, Ron is an active member of the Great Lakes Chapter of Healthcare Financial Management Association (HFMA). He has held numerous positions within the association, including Chapter President, served in National HFMA positions including Chapter Liaison Representative and on the National Advisory Committee (NAC), and presented at the ANI conference. Ron also served on the Small and Rural Hospital Council for the Michigan Health and Hospital Association. Currently, Ron serves on the Audit Committee of a Not-for-Profit hospital, which is part of a national corporation and on the Finance Committee of a mid-sized HMO.
Ron received his Masters in Business Administration from the University of Detroit, and a Bachelor of Arts degree in Economics and Political Science from Kalamazoo College.
As the Director of Revenue Integrity and Payment, Julie draws upon her extensive experience acquired while working in executive-level positions at academic medical centers, integrated health systems, children’s hospitals and with hospital-owned medical groups. She brings over ten years of results-driven leadership experience and a high level of technical knowledge to our clients.
With a focus in revenue cycle management including coding, billing, compliance, and vendor management, Julie has helped to enhance provider financial performance, resulting in improved reimbursement and increased physician compensation while maintaining compliant practices. She has a special interest in process improvement, project management and operational optimization, regularly providing guidance as to best practices and methods that support processes leading to optimal revenue. Julie’s past experiences includes:
- Overseeing the front- and back-end revenue cycle functions for a multi-hospital health system.
- Served as the process owner for a multi-departmental improvement opportunity that reduced billing turnaround from 150 days to 40 days.
- Practice assessments of large specialty practices to evaluate and optimize operational efficiency as well as revenue optimization.
- Evaluation of physician contracts for optimal reimbursement.
- Assistance throughout third-party audits to ensure providers have the resources needed to support documentation, coding and billing.
- Identified revenue opportunities for a facility-based urgent care center leading to an additional $1 million in annual charges.
- Decreased coding backlog for a large integrated care delivery system by 70% utilizing Lean methodologies for production.
- Partner with physician executives to lead documentation improvement efforts for multiple hospitals and clinics.
- Performed analyses for provider-based billing for on- and off-campus sites.
Julie is a highly-requested speaker among professional associations for audiences of both providers and their staff. She has presented at numerous state and regional-level meetings.
Julie graduated from Ferris State University with a bachelor’s degree in healthcare management and earned a master’s degree from Central Michigan University in healthcare administration. She maintains the Registered Health Information Administrator (RHIA), Certified Coding Specialist-Physician Based (CCS-P) and Certified Coding Specialist (CCS) credentials from the American Health Information Management Association. She’s also a member of the Medical Group Management Association (MGMA).
As The Rybar Group’s Director of Client Relations and Business Development, Claudine’s primary role is to work as the business liaison of the organization, focusing on the success, satisfaction and growth of our clients. Over the past thirty years, she has developed an in-depth knowledge of the healthcare industry, having worked in various operational and administrative roles within the hospital, clinical office, pharmaceutical distribution and consulting settings. This knowledge is an important component as Claudine works to foster and develop relationships with our clients and vendors while providing exceptional client services.
Over the years, Claudine has helped shape the strategic direction of a number of organizations. This includes working with several non-profits and for-profits through restructure and change, developing strategies to ensure stability while creating a new framework and plan for growth. She has proven experience in directing business efforts, working to align resources and services to meet the needs of organizations and to lay the groundwork for future growth and stability.
Having worked in a multitude of client service and operational practice areas, Claudine areas of expertise include: Business Operations and Management, Project Management, Strategic Relations, Sales and Marketing, Product Development and Launch, Recruitment and Retention, Contract Analysis, Negotiations and Performance, Purchasing, Strategic Planning and Business Strategies Development.
Claudine graduated with a Bachelor of Arts degree in Communications from Michigan State University, with a minor in Animal Science and Pre-Veterinary Medicine. She is a regular speaker at regional and national conferences, focusing on both technical and soft-skill related topics. She currently serves on the board of directors for a number of non-profit organizations.
As Director of Provider Payment Analytics, Rick offers our clients expertise in the healthcare financial and reimbursement service areas. His expertise covers a wide range of strategic initiatives centered on the complexities of reimbursement and payment for all provider types; including specialization in ensuring rural health providers are optimizing their opportunities.
Rick has worked in a variety of roles in finance departments, including multiple years as a Chief Financial Officer for Acute Care and Rural hospitals, as well as having worked as a consultant for multiple national healthcare consulting firms and for a healthcare payor. Rick’s work was acknowledged when he became the recipient of the 2013 North Bay CFO of the Year Award for his work in Northern California.
Having worked within numerous health systems and hospitals nationwide, Rick has developed a strong understanding of both present and future reimbursement and payment issues and proactively develops strategies to ensure providers are optimizing their opportunities. He offers an in-depth knowledge of accounting, budgeting, reimbursement and revenue cycle functions, including Medicare and Medicaid Cost Reporting, Third-Party Reimbursement, Contractual Modeling, Corporate Compliance, Strategic Planning, Financial Analysis, Budgeting, Decision Support and Payor Reimbursement Systems. His accomplishments include:
- Implemented cost report improvements or numerous hospitals, including work for a rural hospital that resulted in annual rural health clinic reimbursement improvements of approximately $500,000 and for a behavioral health hospital that resulted in increased Medicaid reimbursement of over $1.3 million annually.
- Increased both reimbursement and operational efficiencies through implementation of operational strategies. Key role in identifying and implementing operational improvements for a rural hospital, resulting in increased reimbursement and reduced costs of over a combined total of $1.6 million in a six-month time period.
- Implemented 340b pharmacy programs at rural hospitals. One such program resulted in increased reimbursement of over $700,000 and reduced drug expense of over $1 million annually.
- Worked with a community hospital in developing processes to improve net reimbursement, taking advantage of State programs designed for District Hospitals. Annual reimbursement impact over $2.5 million.
- Successfully merged a new physician practice into the hospital and moved procedures from the office to the hospital resulting in $400,000 of additional reimbursement.
- Work with rural providers to ensure that the hospital qualify for all potential Medicare and Medicaid reimbursement including all Medicaid supplemental reimbursement opportunities.
- Revised the Medicaid application process flow to ensure capture of all potential Medicaid patients at a large urban hospital. Estimated annual increase of 40 million dollars.
- Revised an urban hospital’s contractual model, bringing over six millions dollars in additional reimbursement and revised prior cost reports resulting in an additional eight million dollars in reimbursement.
Rick received his Bachelors degree in Accounting and his Masters in Public Administration degree from Western Michigan University. He is an active member of the Western Michigan Chapter of the Healthcare Financial Management Association, and is serving as the Chapter President Elect and as a member of the Board. In addition, he is a member of the Michigan Association of Certified Public Accountants.
ROSLYN EVANS BOYER, CHFP, MHA
Roslyn has over 30 years of Regulatory Reimbursement and Payment experience and offers our clients expertise in a variety of healthcare provider reimbursement service areas. From her work with multiple national healthcare consulting firms, as well as with one of the Medicare Administrative Contractors (MAC), she offers a broad scope of regulatory reimbursement expertise.
Over the years, Roslyn has developed an in-depth knowledge of Medicare and Medicaid cost reporting and the significant impacts of these documents on the financial success of the organization. This knowledge includes the areas of Balance Sheet Third Party Reviews, Organ Acquisition Reviews, Disproportionate Share (DSH), Medical Education, Bad Debt Reimbursement, Wage Index Analysis, and Filing Appeals and Reopenings. Her accomplishments and experience include:
- Worked as an Audit Supervisor for a MAC, reviewing all of the Auditor work papers for adherence to Medicare and Medicaid reimbursement regulations.
- Reviewed and prepared preliminary and filed Medicare/Medicaid cost reports, including reimbursement analyses design to evaluate if operational practices are appropriately reflected in the cost report. Included work for hospital with medical education, disproportionate share, organ acquisition and ESRD.
- Reviewed organ acquisition for a large urban facility and identified additional Medicare organs to include in the count. The additional organs resulted in over $2.5M additional reimbursement
- Served as the healthcare regulatory specialist for large accounting firm on financial statement audit engagements for Medicare and Medicaid third-party reserves
- Project Manager on a large healthcare engagement for the review and compilation of Medicare bad debts. The review involved four facilities which generated an additional $5M in reimbursement to the client.
- Assisted hospitals with the preparation of position papers for submission to the Provider Reimbursement Review Board for Provider appeals.
- Speaker at external conferences on topics related to Medicare and Medicaid cost reporting as well as changes to those regulations.
Roslyn’s expertise covers a wide range of strategic initiatives centered around the complexities of payment for all provider types and the use of the cost report as a tool for optimizing reimbursement. Her expertise includes Acute Care Hospitals, Psychiatric/Rehabilitation Hospitals, and Skilled Nursing Facilities.
Roslyn received her Masters of Healthcare Administration degree from St. Thomas University and her Bachelor of Science degree in Accounting from Florida State University. She is a Certified Healthcare Financial Professional (CHFP), and is active within the Healthcare Financial Management Association.
As the Service Line Leader in our Critical Access Hospital/Rural Health Division, Caren offers our clients over twenty-five years of Critical Access Hospital (CAH) and other Rural Hospital financial, accounting, revenue cycle and reimbursement experience. She has worked in a variety of roles in the finance departments of CAH’s, including multiple years as a Chief Financial Officer. Caren’s prior provider experience and hands-on knowledge of the issues impacting rural hospitals allows her to identify both present and future reimbursement and payment opportunities.
Caren’s broad experience in multiple facilities has included ensuring that they optimize their payments under their CAH and rural designations. Areas of focus have included financial, reimbursement, cash flow analysis, pro- forma scenarios, accounting, general ledger, financial statements, contractual allowance, contract management and negotiations, operational efficiency, and revenue cycle analysis. Caren brings these areas of focus to effectively assist our clients. Her accomplishments include:
- Successful application submission and conversion of a hospital to CAH status, as well as several clinics to Rural Health Clinic status.
- Lead multiple CAH cost report review engagements that resulted in increased Medicare reimbursement of over 1 million dollars. CAH engagements ranged from solo facilities to system owned CAHs.
- Negotiation and coordination of payer contracts, including those for a new retail pharmacy and CAH Medicare Managed Care contracts resulting in additional reimbursement.
- Work with a number of health systems to implement strategies for optimizing the opportunities of their rural hospitals.
- Assisted clients in implementing a line of credit to provide for a steadier and predictable cash flow.
- As CFO for a CAH, consistently established a culture related to overall financial performance and worked as a leader to sustain a fully operational community hospital.
- Lead cross functional teams focused on various initiatives including the reduction of lost revenue, risk management, internal policies, risk of claims and other revenue cycle related areas.
- Key role in development of community support and fundraising activities in an effort to ensure that the hospital remained open and solvent. Activities exceeded the identified goal.
- Lead role in the implementation of a new financial system while enhancing processes to increase charge capture, reduce claim errors and improve accuracy. Experience with a number of financial and EHR systems, including Dairyland/Healthland, Rollins, Tech Time/MedWorxs, HMS ,Epic, athena and CPSI
- Conducted multiple employee, board, HFMA, Hospital Association and Rural Health presentations, as well as annual open hospital community meetings.
Caren earned a Bachelor of Business Administration degree from Saginaw Valley State University, majoring in Finance. She is a member of the Great Lakes Chapter of Healthcare Financial Management Association and has achieved the status of Certified Healthcare Financial Professional. In addition, she completed the World Class Innovation course through Dale Carnegie.
As an instrumental member of The Rybar Group’s Blue Cross Blue Shield Revenue Strategies service line, Jim offers our clients over thirty years of financial healthcare experience. His extensive knowledge of the third‐party payor reimbursement systems is continually in high demand.
Jim is recognized as an expert in the hospital reimbursement community on Blue Cross Front Sheets, the underlying claims data, and how they are reimbursed through the settlement process. He utilizes this expertise to perform cost report audits for hospitals of various sizes, from Peer Group 5 hospitals to multiple hospital health systems. With a focus on the technical aspects of the Blue Cross Model, Jim works to position clients to identify both present and future opportunities. He specializes in claims related third party payer audits, working with facilities to ensure correct payments. In the past 5 years, Jim has recovered over $13.2 M in additional reimbursement for hospitals from Blue Cross Blue Shield of Michigan settlement reviews. Using 835 files, Jim has developed a Payment Validation process which assists hospitals in understanding their current cash position with the payer, in validating their contractual model and in identifying claims that are receiving less than optimal reimbursement.
Prior to joining The Rybar Group, Jim worked numerous years at Blue Cross, focused on ensuring that projects such as e‐Prescribing, e‐Registration, and e‐Enrollment complied with applicable laws such as HIPAA Privacy and Security, Medicare, and other regulations. He analyzed claims data for data integrity issues and compliance with regulations to ensure proper reimbursement and used data mining to validate and test third‐party settlements to ensure compliance with contracts.
In addition to being a CPA, Jim is a Certified Information Assurance Professional with Trainer endorsement and was among the first people in the country to pass the BS7799 (now ISO 27001) Lead Auditor exam. He has served as a university instructor, teaching both graduate and undergraduate level courses. Jim is a member of the Healthcare Financial Management Association.
Jim holds a Master of Science Degree from the University of Detroit Mercy in Computer Information Systems specializing in management of software development.
With over thirty-five (35) years of financial management, reimbursement and compliance, revenue cycle and operations experience, Deborah offers our clients an expertise grounded in strong technical knowledge and innovative problem solving capabilities. She has held the executive level positions of Vice President, Chief Financial Officer for a post-acute care division of a national Catholic integrated health system; Director of Reimbursement and Director of Special Projects for an Academic Medical Center, and has worked for Big Four accounting firms.
Deborah’s past experience covers a broad range of accomplishments. Highlights of these include:
- Member of a senior management team responsible for the implementation of a competitive plan that enhanced patient care, streamlined services, consolidated facilities, relocated two hospitals and resulted in significant reduction of system costs.
- Captured and analyzed cost data for a nationally recognized academic medical center, identifying opportunities to manage costs. Integral team member in developing operational benchmarks and targets.
- Responsible for developing and managing a corporate reimbursement and revenue enhancement department to provide direction to seven hospital subsidiaries and a nursing home.
- Provided reimbursement and revenue cycle consulting to urban and rural hospitals and clinics as well as home health agencies, an infusion therapy company, inpatient psychiatric hospitals and physician home vising companies.
- Provided litigation support to national law firms as part of a multi-million dollar Qui Tam defense for a multi-state home health organization and hospital based skilled nursing unit, resulting in considerable savings to both organizations.
- Performed revenue cycle audits for various physician practice offices to identify lost charges, inaccurate claims payments and revenue cycle improvement opportunities.
Deborah is currently a consultant on our Volume Decrease Payment (VDP) Adjustment team, working with hospitals nationwide to take advantage of this Medicare reimbursement opportunity. She has prepared VDP requests for Sole Community and Medicare Dependent Hospitals as well as Preliminary and Final Position Papers presented to the PRRB, working to ensure all reimbursement opportunities are optimized.
In addition to her activities, Deborah is an active member of the Eastern Michigan Chapter of Healthcare Financial Management Association (HFMA). She has held the past positions of Chapter President; Treasurer; Secretary and served on several committees. She is also a member of the Michigan Association of Certified Public Accountants. Deborah currently is an adjunct professor in the Master of Health Services Administration program at the University of Detroit Mercy where she teaches various health care accounting, finance, economics and the Capstone classes.
Deborah received her Master’s degree in Health Care Administration and a Bachelors of Business Administration in Accounting from the University of Toledo.
As a Certified Public Accountant, Eric started his career in Public Accounting working as a senior-level accounting professional, focusing in the areas of tax and healthcare across multiple markets. During this time, he developed an expertise in all facets of accounting, including financial reconciliations and financial reporting.
Eric has worked with a variety of Medicare Administrative Contractors to optimize reimbursement for a range of Healthcare providers including hospitals, nursing facilities, home health agencies, Federally Qualified Health Centers, and Rural Health Clinics. Other engagements included Contractual Reviews for a large University Medical Center, Medicaid optimization for regional healthcare systems spanning two-states, Medicaid cost report preparations for various states, and Medicare costrReport preparations and optimizations.
Currently Eric serves as a Reimbursement Analyst on our Provider Payment Analytics team, working with hospitals of various designations, skilled nursing facilities, Federally Qualified Health Centers and Rural Health Clinics to assist them in optimizing their reimbursement and payment opportunities. His focus includes work with contractual reviews, preparation of various cost reports, cost report strategies and governmental and third-party appeals and reopens.
Eric holds a Bachelor of Science in Accounting from Ferris State University. He is also a current member of the Great Lakes Chapter of HFMA.
Jennifer is a subject matter expert in the areas of professional revenue, coding, auditing and process improvement. As a member of the Revenue Integrity and Payment team, Jennifer has worked with providers of a variety of sizes and specialties across the nation, in both inpatient and outpatient settings.
Jennifer’s accomplishments include:
- Perform assessments focused on enhanced provider financial performance, resulting in improved reimbursement while maintaining compliant practices.
- Evaluation of low-paid claims to identify missed revenue opportunities.
- Complete audits of professional documentation and coding for clients in a variety of settings including large medical groups, independent physician practices, health systems and long term care facilities. Specific audits include:
- Annual review for clinic and hospital-based services for a health education center including complex specialties for continual education to providers
- Outpatient facility services including diagnostic services, procedures, and emergency department leveling
- Evaluation and management (E/M) services for a wide range of specialties
- Provide education related to regulatory requirements and reimbursement opportunities for providers and their staff.
- Assessment of computer-assisted coding (CAC) output to ensure coding was captured appropriately based on clinical documentation.
- Work with a number of attorneys providing litigation support.
- Active involvement as an independent review organization (IRO) for providers under corporate integrity agreements (CIAs) initiated by the OIG.
- Review of policies and procedures for validity, accuracy, efficiency, and compliance with any applicable rules and/or regulations.
- Support with software evaluation and implementation related to audit tracking and completion
In addition, Jennifer has worked with a variety of electronic medical record systems, including Epic, Cerner, eClinicalWorks, Allscripts, and MEDITECH.
Jennifer earned her bachelor’s degree in Health Information Management from the University of Cincinnati and holds the Registered Health Information Administrator (RHIA) credential. She is an active member of the American Health Information Management Association (AHIMA) as well as with the Michigan chapter (MHIMA). She also serves on the Baker College Advisory Board, developed to support educators in continually evaluating program curriculum to ensure relevance in the healthcare industry.
Tammy currently serves as a Reimbursement Analyst on our Provider Reimbursement and Analytics team, working with hospitals of various designations to assist them in optimizing their reimbursement and payment opportunities. Her focus includes work with contractual reviews, Blue Cross Blue Shield Revenue Strategies, and Governmental and third-party appeals and reopens.
Over the past four years, Tammy has been assisting the clients of The Rybar Group with various Medicare related appeal opportunities. She has developed an expertise in providing reimbursement, financial and data analysis related services.
Tammy served as a Support Specialist for our Volume Decrease Payment (VDP) Team, assisting hospitals nationwide to take advantage of this reimbursement opportunity. This included work on VDP requests for Sole Community and Medicare Dependent Hospitals. In addition, she worked on client third-party appeals and cost report structure reviews to ensure all reimbursement opportunities were optimized. Along with the VDP consultant team, Tammy focused on identifying improved reimbursement opportunities for our clients.
As part of her activities, Tammy worked on not only compiling the necessary data and documentation for the appeals, but also performed analytics on the information based on the regulatory requirements. She served as a point person, following up on the appeals with the Medicare Administrative Contractors, and communicating needs to the clients. She collected and analyzed various benchmark data from the hospitals on a monthly basis, analyzing the information for additional appeal opportunities. Through the appeal process, Tammy worked on various components and worksheets of the cost reports. In addition, Tammy developed and implemented numerous processes to streamline the appeal process and tools that could be used by the clients for reporting purposes.
Tammy holds a Bachelor of Science in Accounting Fraud from Davenport University.
Kim offers the clients of The Rybar Group a range of expertise in the area of Health Care Data Analysis. Along her career path, Kim has worked with data in various roles and in a multitude of industries, including from the Medical Devices and Pharmaceutical industries. Her experiences include:
- Data Analytics and mining to assist in identifying opportunities and trends, including work with payment validations, tracking low volume decrease and Critical Access Hospital measures.
- Performing disproportionate share audits, tracking trends, variations and other key indicators and creating reports and data visualizations for both internal consultants and external client needs.
- Data extraction, transformations and load on a multitude of data including: quarterly CMS Hospital Cost Reports data, hospital, payor reimbursement and facility coding data.
- Design, development and implementation of systems to improve the effectiveness of internal information systems and to meet immediate and long-range departmental and corporate goals.
- Proficient in working with multiple databases and with several programming languages. Includes Microsoft Access 2003-2010, SAS, MS SQL, Server 2005/2012, as well as programming in VBA, SQL, HTML and VB Studio and with JMP and Tableau.
- Proficient in Excel, utilizing functions, creating macros and Visual Basic projects, Analysis ToolPack and Solver to perform analytics including creating optimization and simulation models and using pivot charts and tables to visualize the information.
- Process modeling and documentation including workflow process modeling.
In addition, Kim has experience as a systems implementation specialist, where she installed and configured systems and interfaced the software with other devices. This includes interpreting customer requirements, defining and designing proposed solutions and creating custom reports and dashboards. Kim has served as a WinSPC and statistical process control instructor, and she co- authored a WinSPC Administrator Manual.
Kim holds a Masters degree in Information Technology Management from Oakland University.