About Us

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.

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.

Our diverse client base includes:

• Health Systems
• Hospitals
• Group Medical Practices
• Specialty Clinics
• Healthcare Law Firms
• Rehabilitation Hospitals
• Behavioral Health Providers
• DME Providers
• Clinical Laboratories

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Tip of the Month

CMS Final Rule:  Medicaid RAC Regulations

Under the Final Rule, states must have Medicaid RAC programs in place by January 1, 2012.  The Final Rule contains specific requirements that state Medicaid RAC programs must satisfy upon implementation. 

• States must coordinate the recovery audit efforts of their Medicaid RACs with other auditing entities, including state and federal law enforcement agencies.
• States must set limits on the number and frequency of medical records to be reviewed by the Medicaid RACs subject to requests for exceptions made by the RACs.
• Medicaid RACs cannot review claims that are older than three (3) years, unless it receives approval from the state.
• States may exclude Medicaid managed care claims from review by Medicaid RACs.
• States must ensure that adequate appeal processes are in place for providers to dispute adverse determinations made by the Medicaid RACs.

The Department of Health and Human Services estimates that the Medicaid RAC program will result in the return of approximately $2.1 billion in overpayments over the next five (5) years, of which $900 million will go back to states.