KYLE W. LEE

Consulting firm specializing in healthcare reimbursement and revenue management, cost report filings and reopenings, ER Physician tracking, revenue recognition analyses, cost analyses and healthcare reform

• Provide strategic consultation for hospitals and health systems
• File cost reports and reopenings for hospital and health system clients of varying complexities
• Improve ER Standby reimbursement
• Identifies provider-based opportunities of clinical operations for PPS and Critical Access Hospitals
• Evaluate physician practice structures in relation to revenue opportunities
• Review contractual models to assure accurate allowance calculations
• Communicate with providers regularly on regulatory changes and opportunities and mitigation plans
• Analyzes performance of distinct part unit and recommends adjustments in management for optimal performance
• Leads engagements for large tertiary urban providers and small rural providers including Medicare Bad Debt capture, Disproportionate Share enhancement, cost report reviews and audit defense, provider-based evaluations and physician relationship structuring
• Performs Charge Description Master reviews and service line optimization
• Guides providers on regulatory changes
• Evaluated large system’s Reimbursement function and made recommendations on restructuring for better performance

Large fully integrated health system includes eleven urban and rural hospitals with DSH, distinct part units, Skilled Nursing Facilities, Critical Access Hospitals, approximately 28 Rural Health Clinics, Nursing Facility, home office reports, large physician practices and related insurance plan

• Rebuilt in-house Reimbursement function, created Managed Care Finance division, oversaw payment assurance and contract performance analyses
• Evaluated and negotiated select contractual arrangements, quantified financial impact and payor performance for all contractual negotiations
• Oversaw all aspects of Charge Description Master and directed charge capture and reconciliation opportunities with clinical departments
• Served on various system committees including Compliance, Legislative and clinical service lines including Cardiology, Supply Chain, Seniors and Women & Children
• Managed Medicare profitability plan to stabilize and increase Medicare payments
• Identified opportunities and lead initiatives for seven newly certified Critical Access Hospitals (CAH) which increased reimbursement $2.9M annually
• Directed analyses of provider based compliance and opportunities identifying $1.0M in potential reimbursement
• Managed identification, analyses and implementation of Rural Health Clinics
• Analyzed operations of inpatient Psychiatric unit and suggested changes which increased reimbursement by $1.2M

Largest fully integrated system in Kentucky with annual net revenue of $850M; includes five urban and two rural hospitals of varying size and complexity, teaching programs, distinct part units, SNFs, a Critical Access Hospital, rural health clinics, large physician practices and a home office

• Oversaw in-house Reimbursement function, Charge Description Master, Revenue Integrity and Revenue Improvement areas; supported Managed Care negotiations and payment assurance
• Served on Revenue Cycle Committee which increased 2002 net patient revenue for entire system by $66M
• Analyzed operations of inpatient Psychiatric unit and suggested changes which increased reimbursement by $500,000
• Increased reimbursement by $900,000 per year through the implementation of a system-wide policy and review of Medicare bad debts
• Implemented annual pricing review resulting in an increase in net revenue of $9.8M
• Calculated net patient revenue budget, monitors actual net patient revenue and produces net patient revenue variance reports for each hospital corporation
• Managed the state’s largest provider of Medicaid services through the implementation of a prospective payment system
• Addressed the majority of the OIG work plan for various years and recommended actions to assure minimal exposure to the system
• Presented series of educational sessions emphasizing clinical and financial collaboration on reimbursement and charge capture importance
• Served on various state and local committees representing health care providers

Largest fully integrated system in eastern Oklahoma; includes 14 urban and rural hospitals of varying size and complexity, teaching programs, Long Term Acute Care Hospital, organ acquisition programs, distinct part units, large physician practices, an independent histology laboratory and a home office

• Built and oversaw in-house Reimbursement function for growing system; filed first Home Office cost reports for system and oversaw audit and settlement of reports
• Suggested operational changes in Children’s hospital resulting in an increase in net revenue of approximately $850,000
• Facilitated satellite locations of Long Term Acute Care Hospital into acute care hospitals resulting $400,000 in net revenue
• Analyzed operations of cost-based reimbursement units and found methods of systemization to enhance patient care and increase reimbursement by $250,000
• Oversaw, reviewed and performed reimbursement analyses within the due diligence process of potential acquisitions including four hospitals
• Instituted internal control measures to assure integrity of Intern & Resident data
• Organized reimbursement council made up of area facilities’ representatives; initiatives included maximization of Metropolitan Statistical Area wage index and the audit of the allocation of shared Intern & Resident FTEs
• Lead system-wide implementation teams for Ambulatory Payment Classification (APC) preparedness which addressed financial impact analyses, facility check lists addressing operational, clinical /coding/billing issues and monitoring of payments

Fully integrated system included 14 hospitals resulting from the merger of Presbyterian Healthcare System and Harris Methodist Health Systems, providers included large, complex, teaching hospitals with PPS excluded units, a home office and smaller hospitals with rural health clinics

• Supervised professional reimbursement staff, performed general reimbursement functions including intermediary interaction, audit support, payment rate reviews, reopenings, appeals, contractual estimates and consultation with operation and administrative personnel to optimize reimbursement
• Served as member of various government affairs and legislative liaison committees
• Compiled charity status reports for the corporation on a regular basis and filed the Annual Statement of Community Benefits to the Texas Department of Health
• Audited substantial managed care payors to ensure accuracy and contract compliance

• Applied professional knowledge and expertise to effectively manage teams in the auditing of Medicare cost reports of providers of varying sizes and diverse issues