Healthcare Consulting & Reimbursement

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
• Guidance on improving processes and leveraging systems to streamline reporting and compliance requirements

The Health Resources & Services Administration (HRSA) 340B Program has a myriad of regulations and compliance requirements, which often leave covered entities feeling overwhelmed and concerned. HRSA recently switched their audit focus from commercial hospital environments to nonprofit covered entities and contract pharmacy arrangements. A finding of non-compliance can result in sanctions, removal from the Program, and/or repayment to manufacturers.  Additionally, HRSA has recently clarified that covered entities utilizing a contract pharmacy are required to have an annual independent audit of the Program.

AAFCPAs’ Healthcare practice has deep expertise in federal 340B program compliance. We help clients:

• Successfully prepare for an Office of Pharmacy Affairs (OPA) audit,
• Ensure 340B Program integrity and maintain accurate records documenting compliance with all 340B Program requirements, and
• Mitigate major risks associated with the 340B Program.

Learn more about AAFCPAs’ 340B Pharmacy Program Audit & Consulting>>

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.

The exposure we gain from serving 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.  We advise our clients on strategies to optimize reimbursements under the PPS, 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