The Toiyabe Group (TTG) has provided coding, pricing and billing expertise to numerous acute care hospitals, medical group practices, prepaid healthcare service plans, and allied health professionals. In all aspects of our consulting services, regulatory compliance has been of primary importance. The senior officers of our firm have extensive backgrounds in acute care hospital settings and medical practice, accounts receivable management, complimented by hospital finance experience, accounting management, and information system support.
As a recognized leader in healthcare consulting, The Toiyabe Group, Inc. (TTG) is committed to conducting business with a high degree of integrity in compliance with all applicable federal, state and local laws. TTG serves healthcare providers nationwide, utilizing a sophisticated communications network to stay on the leading edge of regulatory compliance. Today's healthcare environment requires solid bottom-line performance. Our consultants can guide you through the labyrinth of reimbursement, billing and compliance issues and admission documentation criteria. Our specialists can help you minimize your organization's exposure to non-compliance issues regarding Medicare & Medicaid regulations. TTG is fully HIPAA compliant taking every measure to exceed the current regulatory standards.
TTG offers personalized, professional services using a multi-disciplinary team approach comprised of experts in coding, billing, charging, clinical documentation, workflow analysis, medical necessity criteria as well as forensic accounting and fraud examiners.
Dick Derby, CFO, Barton Health:
The Toiyabe Group, Inc. (TTG) worked with the Barton Health on several Revenue Cycle projects which have had a measurable and quantifiable increase in our net revenue. TTG has also worked with our Nursing and Ancillary Department staff on several quality initiatives which have had a favorable impact upon our ability to support medical necessity, inpatient short-stays and the observation level of care. TTG works closely with our Nursing and Ancillary Department managers in implementing recommendations through in-service training and monitoring activities to ensure the success of the project while improving our financial position.
James Eastham, FACHE, former President and CEO of Valley Baptist Health System:
The Toiyabe Group, Inc. (TTG) worked with the Valley Baptist Health System Department Directors involved in the Revenue Cycle process. TTG performed a comprehensive Charge Description Master Audit, Review and Update and a Pricing Review for our facilities. This comprehensive review and analysis contributed directly to a significant increase in reimbursement and cash flow. A corresponding reduction in Recovery Audit Contractor (RAC) denials was achieved through more accurate coding of our Health System Charge Description Masters. TTG's quality initiatives were focused to improve our physician and nursing documentation as well as working directly with our Case Managers. TTG's focus was on improved financial performance, while maintaining regulatory compliance, and worked closely with our Management Team in implementing recommendations and providing in-service training which directly contributed to our improved financial position .
CMS Rebilling Rules
On March 13, 2013, the Centers for Medicare and Medicaid Services released two (2) rules proposing to revise its current position on Medicare claims denied by Medicare contractors and recovery audit contractors as well.
It now appears that providers will generally be eligible to receive payment under Medicare Part B for those services that are deemed to be reasonable and necessary assuming the Medicare beneficiary had been treated on an outpatient basis by the provider. Heretofore, the eligible Part B services which were denied by the Medicare contractor or RAC were not eligible for payment under Medicare Part B.