Providing Specialized Accounting Services to the Legal and Corporate Communities

Healthcare

healthcare

Healthcare

  • Served as a department supervisor for a 20-person department as part of a cash acceleration and business office redesign engagement. Due to this company’s significant age and amount of accounts receivable we were retained to “clean-up” the business office and accelerate the recovery of accounts receivable. Mr. Taylor was responsible for the supervision of a department which included billing and collection functions. Various billing and collection procedures were created and implemented to assist the billing and collections staff to improve overall efficiency.
  • Prepared process documents to identify operational improvements and assisted in the implementation to redesign back office operations of a Durable Medical Equipment (DME) organization. This publicly traded company engaged us to perform a back office redesign to improve overall efficiency and the collection of accounts receivable. Our work consisted of performing comprehensive interviews with the individuals involved in the process, documentation of existing processes and procedures and development of new processes and procedures.  We also established policies and procedures and increased overall recovery of outstanding accounts receivable.
  • Provided training to the healthcare community related to the Medicare Outpatient Prospective Payment System (OPPS) and the new Medicare provider-based rules. Mr. Taylor presented at two seminars held in Phoenix to provide specific details and guidance related to the OPPS rules which changed the way hospitals were paid for outpatient services. Numerous local hospital representatives attended to learn about the coding requirements, elected coinsurance amounts and the proposed provider-based rules.
  • Created a financial model to determine the feasibility of a hospital acquisition in rural Idaho.  We were engaged to determine a purchase offer of a local competitor hospital owned by a physician group who announced their interest in selling their hospital. Our work was designed to develop a purchase offer and to identify the source of the funds to purchase the hospital.  We developed a five-year forecast to assist our client in determining the feasibility of purchasing the hospital.
  • Prepared a complex financial model to assist a 12 hospital region in southern California related to SB1953. We were engaged to work with architects to determine the cost of meeting the California law and determining how the hospital region could fund the costs. The model was designed to identify both revenue and costs in eight different inpatient service disciplines and also took into consideration changes in the hospital operating structures. The final model provided management with the feasibility of funding these changes through operations and the implications to the organizations financial health.
  • Provide Medicare cost report appeal services to a number of hospital clients.  This work includes analyzing audited Medicare cost reports, filing requests for Board hearings with the Provider Reimbursement Review Board (PRRB), preparing preliminary and final position papers, working with the Intermediaries or the Medicare Administrative Contractor (MAC) to administratively resolve issues and attending or testifying at PRRB hearings.
  • Provide regulatory and compliance consulting for more than 15 hospitals and health systems in the State of Arizona. These services are designed to validate an organization’s payor mix to ensure their related reimbursement payments are made in accordance with federal regulations. The results of the validation procedures ensure hospital compliance with current regulations and typically increase overall hospital reimbursement. Mr. Taylor has issued more than 100 reports resulting in over $60 million in recoveries of additional reimbursement.
  • Prepared various financial models and analysis to assist a Tucson-based hospital in a number of Medicare reimbursement areas including DSH and GME/IME.  Also assisted the hospital in structuring its medical residency programs to comply with the Medicare regulations and to create a program structure which enabled the hospital to build a larger residency program in future periods.
  • Performed a review of a multi-hospital medical education program to resolve numerous issues which existed from when the program was first started by the hospitals.  This work included the resolution of numerous reopening and appeals to ensure the hospitals were properly reimbursed GME and IME from the Medicare Program.
  • Provided many hospitals with consulting services related the payment of Medicare bad debts.  This work involved revising bad debt logs, filings appeals and reopenings and working with the local Intermediary to resolve these bad debt issues which resulted in increased Medicare reimbursement for the hospitals.
  • Developed and lead an administrative appeal related to Arizona hospital reimbursement of Medicare payments. Mr. Taylor is serving as the technical expert on this dispute related to the proper use of the Medicare Disproportionate Share Hospital (DSH) payment formula. Work on this engagement consists of verifying the total claim filed against Medicare, gathering facts and evidence to support the hospital claim and serving as a technical resource for the preparation of position papers.
  • Performed a review of a large health systems medical education intern and resident count for Medicare reimbursement purposes. This review consisted of identifying all compensated hospital interns and residents, validation of their eligibility and education credentials, review of hospital prepared rotation schedules, review of current Medicare regulations and the computation of the final FTE count. Our final report was used to obtain the appropriate amount of reimbursement from the Medicare Program.
  • Completed routine cost limit exception requests for a large Arizona health system related to their hospital-based skilled nursing facilities (SNF). Medicare regulations allow an adjustment to an established routine cost limit based on certain qualifying criteria being met. Our work was designed to review the SNF’s costs and care of patients to determine if the SNF qualified for an exception and to what extent. This work was performed by reviewing Medicare cost reports, trial balance and financial statement information and activities of daily living. Based on this information we determined if the SNF qualified and prepared a request for exception to be filed to the Medicare Program.
  • Prepare Medicare cost reports for many hospitals located in the western region of the United States. Preparation of the cost report requires an in-depth understanding of the cost report forms and the regulations related to being reimbursed under the Medicare Program. The cost reports were prepared using hospital documents such as financial statements, financial account details and various statistical information.
  • Provide Medicare cost report appeal services to a number of hospital clients.  This work includes analyzing audited Medicare cost reports, filing requests for Board hearings with the Provider Reimbursement Review Board (PRRB), and preparing preliminary and final position papers.
  • Brent Taylor spent three years as a Medicare auditor for Blue Cross Blue Shield of Arizona. This included auditing numerous Arizona hospital and skilled nursing facility Medicare cost reports. The audits performed required review of key hospital documentation such trial balance data, census reports and statistics such as square footage and hospital FTE’s. The audits were also designed to review key reimbursement payments such as bad debts, medical education and DSH. Mr. Taylor also served as the wage index auditor-in-charge for a two-year period.

Additional Engagements:

  • Provide consulting services related to medical education services including recalculating base year per resident amounts, establishing new programs, computing resident caps, determining resident FTE counts, and establishing temporary changes to resident caps through various provider agreements.
  • Prepared a damage calculation related to a dispute between a managed care organization and a laboratory services provider.
  • Prepared and filed numerous Medicare appeals and reopening requests including partial and full administrative resolutions for various appeal issues.
  • Prepared financial models for feasibility studies related to hospital expansions, the development of new providers or services, and to comply with various state mandates regarding hospital construction.
  • Analyzed contracts and computed reimbursement discrepancies related to case management services between a large healthcare organization and various state agencies.
  • Analyzed large amounts of complex data to compute overpayments related to a large healthcare organization’s medical supply services.
  • Computed damages related to a breach of contract dispute between a pharmaceutical company and a drug marketing organization.
  • Analyzed payor data of a health care provider in comparison to the payments made by an insurance carrier.
  • Review supply transactions to determine appropriateness for Medicare billing.
  • Analyzed client billing and payment practices.
  • Investigated the practices of benefits manager as it related to a contract to evaluate compliance.
  • Performed a business review on behalf of a creditor organization to determine the financial health of a health system.
  • Performed investigations of hospital Medicare bad debts.
  • Performed financial audits for hospitals related to third party reimbursement and Medicare payments.