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Healthcare Consulting & Reimbursement

AAF fully understands the complexities of the healthcare industry and offers proven and valuable solutions to help you meet your business goals.

Healthcare Consulting & Reimbursement

Healthcare Consulting & Reimbursement Services

AAFCPAs has over 40 years of experience helping healthcare organizations reduce costs, streamline efficiency, improve third-party collections and enhance overall success.  AAF’s Director of Healthcare Consulting & Reimbursement brings over 27 years of experience in the healthcare industry.

Healthcare Consulting & Reimbursement solutions include:

Healthcare Consolidation & Coordination of Care

AAFCPAs has witnessed dramatic changes in the healthcare industry, including the current consolidation landscape and integration of behavioral health into the primary care delivery system.  Our specialists are well-prepared to advise clients on forging innovative partnerships or consolidations that will improve the quality of care and clinical outcomes while controlling costs.  We help clients to perform well-executed integrations that optimize both outcomes and profitability.

Healthcare Consolidation Advisory Solutions include:

  • Vetting potential healthcare partnering arrangements, including: comparative analysis of competition, cost structures & payment methods, practice patterns, quality of care, and clinical outcomes
  • Guidance on changes in reimbursement and regulatory frameworks and the increased proliferation of high-deductible health insurance plans
  • Analysis of Accounts Receivable & Third Party Reimbursement
  • Optimizing ROI on technological investments, and aligning business process controls with performance objectives

Data Driven Patient Care

As Healthcare providers are moving to new value-based reimbursements models, payers are pushing for proven treatment and performance measures.  Providers can no longer simply concentrate on reducing patient symptoms, but must demonstrate long term care recovery with auditable data. AAFCPAs provides clients with better data management & collection tools and processes to efficiently capture and report on patient care, and clinical outcomes.  AAFCPAs specializes in developing business process and controls for collecting and advantaging data to provide analysis on: provider activity, delivery of care, and analysis of efficiency & cost effectiveness.

AAFCPAs provides guidance on:

  • Evaluating and changing internal controls and processes to produce reporting that is uniform and auditable
  • Best practice recommendations to enable your organization to capture the necessary information and statistics
  • Establish protocols to monitor activity on an on-going basis

340b Pharmacy Program Audits

The pharmaceutical provider industry has grown significantly in the past few years. Among these changes has been the development and implementation of the Federal 340b program, enabling participants to stretch scarce Federal resources to provide more comprehensive services to an expanded group of eligible patients. The program has detailed compliance requirements and participants are struggling to understand, comply with, and monitor these requirements. Scrutiny by the Health Resources Services Administration (HRSA) had been mainly focused on for profit hospital environments; however, the focus is now shifting towards Health Centers and contracted pharmacies.

The Health Center who contracts with a retail pharmacy chain is responsible for all compliance requirements with the program. A finding of non-compliance with the program can mean sanctions, being removed from the program and/or repayment to manufacturers for the period of the violation. The Health Center should consider if the proper controls and procedures are in place to adequately maintain the program in accordance with Federal guidelines.

AAFCPAs performs program audits of both on-site and contract pharmacies. This enables Health Centers to monitor compliance and reduce any potential risks from an Office of Pharmacy Affairs (OPA) audit.

Optimizing Reimbursement

In order to maximize reimbursement, health care organizations need to ensure their internal controls and processes are properly designed and are operating effectively. We are available to consult to ensure patient revenue reimbursement is maximized and the process is efficient.

Operational Assessment

Health care organizations need to constantly evaluate and assess their practice management operations. The practice management operation is a complicated process which needs to be properly designed from the front-end through the back office operations. AAFCPAs performs internal control reviews of the practice management operation. This involves assessing the controls and procedures at the front end through the various layers of processes through the collections of accounts receivable. We make recommendations in areas where clients can increase reimbursement and improve operational efficiency.

Denials Prevention and Management

Most denials are caused by inefficient processes and can be prevented. Denials can be caused by internal issues, technology issues or billing complications from third party payors. Interpreting the billing and coding requirements of a variety of payors can be challenging. AAFCPAs performs a review of denials to identify opportunities to minimize denials and increase reimbursement. This includes identifying the causes for the denials and common themes. If the denials are caused by internal factors, we can provide training to prevent the denials from reoccurring. If the denials are caused by external payor issues, we work with clients to develop an action plan to address these with the insurance companies.

Tracking and Monitoring Risk Based Contracts

Through the implementation of the Affordable Care Act, the reimbursement model is changing. AAFCPAs is at the forefront of the changes in the healthcare industry. Reimbursement is shifting from fee for service to bundled payments through risk based contracts. AAFCPAs provides guidance to clients as they enter into these contracts.

We work with our clients to develop tracking and monitoring systems for risk based contracts. This involves determining the costs for providing the services to be covered under the contract. In addition, we also help to develop a system to monitor the services being provided and costs involved. The profit/loss on these contracts needs to be determined as well as how much is attributable to the organization. We consult on the level of reserves that are necessary for these contracts, and the accounting and financial reporting requirements.

AAFCPAs has spent four decades providing incisive financial knowledge and strategic management advice to help our clients obtain optimal reimbursement, maintain regulatory compliance, increase cash flow and sustain performance. We fully understand the complexities of the healthcare industry and offer proven and valuable solutions to help you meet your business goals.

Interim CFO Services

In addition to best-value assurance and exceptional tax expertise, AAFCPAs provides executive level accounting and finance function solutions for community health centers, physician practices, long term care, and home care & hospice providers. Our industry specialists have a comprehensive understanding of the nuances of the healthcare industry.  We work collaboratively with agency CEOs and governing Boards in the development of long and short range operations plans and capital budgets as supported by the organization’s objectives.  We assume a lead role in exploring and implementing means of managing and improving the financial performance of the organization.  We also oversee internal accounting controls, all areas of receivables management, and other business office systems and procedures to achieve efficiencies in the business office.

Guidance for FQHCs on Optimizing Reimbursements Under Medicare’s Prospective Payment System (PPS)

The exposure we gain from serving 26 Federally Qualified Health Center (FQHC) clients in multiple states is unmatched by our peers and allows us to provide cutting-edge guidance on changes in reimbursement and regulatory frameworks.   AAFCPAs has been providing critical guidance to our FQHC clients transitioning to the new Medicare Prospective Payment System (PPS) methodology, effective in 2014.  We continue to help clients optimize reimbursements under this new payment methodology, and keep up-to-date with annual changes implemented by the Centers for Medicare and Medicaid Services (CMS).

Medicare PPS Advisory Solutions include:

  • Training of personnel (including scheduling/reception, clinical/provider, billing & finance) on billing systems, billing methodologies, and cost report preparation
  • Timely alerts and advice related to rate adjustments, and new or discontinued G-Codes
  • Review of internal fees and costs to ensure you are maximizing reimbursement
  • Review of records to ensure Medicare gross patient revenue, and related contractual allowances and reserves are reported adequately in your financial statements