Services
Operations, reimbursement, capital, Medicaid policy, quality, and the reports those decisions rest on. Each engagement is scoped as a model, a decision, or a filing.
01
Budgets that ignore census mix, overtime, and agency spend rarely hold through the first quarter. We build operating models from occupancy, payer, and labor, then reconcile them to the GL so leadership is working from the same numbers.
02
We review the cycle as a conversion of authorized care into collected revenue. Typical work includes denial root-cause, payer-mix yield, contractual modeling, and a 90-day action list with owners.
03
From CAH status questions to SNF PDPM, FQHC PPS, and LTCH site-neutral rules, we model the payment path before a commitment is made. The output is a decision memo covering options, dollars, risk, and assumptions.
04
We advise on capital structure, debt placement, campus redevelopment, and operating turnarounds. Work includes sources-and-uses, covenant capacity, joint-venture economics, and a board memo that ties the project to cash and operations, not only to the architect's drawing.
05
We advise state agencies and providers on Medicaid design, 1115 waivers, state plan amendments, capitation and rate setting, PACE and MLTSS, and intergovernmental and supplemental payment structures. The work is written so CMS, the budget office, and operations can use the same numbers.
06
Quality reporting becomes a finance problem when it threatens the annual payment update or the survey cycle. We map measure submission, data gaps, and staffing-star math to the operating plan and, where it matters, to the cost report.
07
Multi-entity senior living and hospital systems often break down around management fees, related parties, restricted funds, and debt covenants. We build the consolidating view, the covenant forecast, and the package bondholders and boards use.
08
We prepare and review CMS cost reports for hospitals, SNFs, HHAs, hospices, FQHCs, and related entities. Work includes trial-balance mapping, statistics, related-party schedules, PS&R reconciliation, and a closing memo covering margin, APU risk, and next-year planning. The report is treated as one product among others, not the whole engagement.
09
Fractional to full-time accounting support from CFO-level leadership and controllership through staff accounting and data entry. Flexible coverage when a provider needs capacity, continuity, or an interim finance team.
Engagement readiness
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This is a checklist, not a grade. Unchecked items become the workplan.
Industries
Service-line yield, program election, price transparency, capital, and system reporting.
PDPM, Five-Star staffing, labor, Medicaid, and operating performance.
Multi-entity consolidations, entrance-fee accounting, covenants, and campus capital.
PPS wrap, UDS, sliding-fee, 330 grants, and visit-level productivity.
PDGM, visit productivity, cash conversion, and cost reporting.
Hospice cap, visit productivity, cash conversion, and cost reporting.
Medicaid, PACE, MLTSS, LTCH, and behavioral health payment and policy.