Consultants

Below are the profiles of each member of our consultant team. Please feel free to contact us to speak to them.

Ronald K. Rybar, FHFMA, CMPA

As the founder and President of The Rybar Group, Ron offers nearly thirty (30) years of experience in healthcare financial management to our clients. Ron began his career working in the Finance department of various Michigan hospitals, before becoming a consultant with a national public accounting firm, focusing on healthcare clients. He formed The Rybar Group in 1989 with the mission to provide quality service to healthcare management, while assisting them in maintaining financial viability through compliant, efficient business operations. he has spent the past twenty-one (21) years leading The Rybar Group in becoming a nationally recognized premier healthcare consulting firm.

Over the years, Ron has worked with providers nationwide on engagements related to data integrity and compliance with federal and third-party payor regulations. He has provided litigation support for a variety of providers and provided testimony in Federal District Court as an expert witness. He has successfully negotiated with Medicare and Blue Cross Blue Shield on hearings, completed numerous Sole Community and Medicare Dependent Hospital Low Volume Adjustment exception requests, negotiated PPO and managed care arrangements on behalf of hospitals, and negotiated in joint-venture situations.

Additional achievements and activities include numerous Interim Chief Financial Officer engagements, cost report preparation, reimbursement and revenue estimating studies for hospitals, home health agencies, hospices and SNF's, and the completion of numerous strategic pricing analysis and feasibility studies for health-related facilities. He has assisted in corporate reorganization, establishment and set-up of new corporate entities, and provided financial training for corporate board members, as well as for associations such as the Healthcare Financial Management Association (HFMA).

In addition to his activities, Ron is an active member of the Great Lakes Chapter of HFMA. He has held numerous positions within the association, including President. He has served in National HFMA positions including Chapter Liaison Representative and on the National Advisory Committee (NAC). He currently serves on the Small and Rural Hospital Council for the Michigan Health and Hospital Association.

Ron received his Masters in Business Administration from the University of Detroit, and a Bachelor of Arts degree in Economics and Political Science from Kalamazoo College.

Michele Causley, MBA

Michele oversees the Provider Reimbursement Analytics Department, which consists of the Rural Health/Critical Hospital Division, the Blue Cross Division and the Low Volume Adjustment Division of The Rybar Group. Through this role, she has developed multiple long-term relationships with clients, providing superior communication and expertise on reimbursement, payment and regulatory related issues.

Since joining The Rybar Group, Michele's focus has been on assisting our clients in ensuring that they are optimizing all reimbursement opportunities. This includes a heavy emphasis on reimbursement, cost report preparation and reviews, appeals, and special analytical projects. During her twenty-five (25) years of business operations and financial management experience, Michele has worked in a variety of industries, accumulating a broad range of management experience.

Michele expertise includes Sole Community and Medicare Dependent Hospital Low Volume Adjustment requests, assisting multiple facilities with successful appeals. She works with Providers and medicare Audit Contractors nationwide assessing eligibility and obtaining substantial additional Medicare reimbursement for facilities that meet the regulatory guidelines. Additional activities include:

Leadership in cost report preparation;
Third-party audits, appeals, and reopens;
Cost report structure reviews;
Occupational Mix Survey completion;
Preparation of special payment requests;
Financial analysis; and
Forecasting and financial impact studies.

In addition, Michele has successfully completed mediation of several PRRB cases.

Michele holds a Masters of Business Administration degree from Loyola Marymount University and is a current member of the Great Lakes Chapter of Healthcare Financial Management Association, serving on its Program Chair.

James L. Hedges, CPA, CIAP-T, MSCIS

James has over nineteen (19) years of financial healthcare experience and holds a Masters of Science Degree from the University of Detroit Mercy. He has extensive knowledge of payor reimbursement systems, including Blue Cross Blue Shield of Michigan.

Jim is recognized as an expert in the Michigan hospital reimbursement community on Blue Cross front sheets, the underlying claims data, and how they are reimbursed through the settlement process. He has performed cost report audits for hospitals of various sizes, including multiple hospital health systems, as well as conducted multiple Contract Payment Management Reviews. Jim focuses on the technical aspects of the Blue Cross Model identifying opportunities for facilities. Jim specializes in claims related Blue Cross audits working with facilities to ensure correct payments.

In addition, Jim has worked to ensure that projects such as e-Processing, e-Registration, and e-Enrollment complied with applicable laws such as HIPAA Privacy and Security, Medicare, and other regulations. He has analyzed claims data for data integrity issues and compliance with payor regulations to ensure proper reimbursement, has used data mining to validate and test third-party settlements to ensure compliance to contract, and works to identify opportunities to recover lost revenue for providers through the use of 835 tables.

Jim is a Certified Information Assurance Professional with Trainer endorsement through the National Security Review Board. He has served as a university instructor, teaching graduate and undergraduate level courses. Jim is a member of the Healthcare Financial Management Association.

Jeffery S. Nagy

During his past ten (10) years of experience in healthcare financial management, Jeff has worked in the finance area of various public accounting and audit firms as well as within a healthcare provider network. He specializes in working with Critical Access Hospitals, Rural Health Clinics and Psychiatric Hospitals.

Jeff's experience includes the performance of Chief Financial Officer functions, including oversight of purchasing, billing, payroll and the accounting staff, and work in both the financial and operational areas for the non-profit industry, providing recommendations and having decision-making responsibilities. He has participated in the start -up of a provider network; activities included the set-up of the network billing systems, organizational chart development, strategic goal planning, and other development planning, and prepared financial and operational budgets and monthly financial statements.

More recently, Jeff's accomplishments include cost report preparation and review, third-party audits and appeals and preparation of reports and special payment requests filed with third-party payors. He has prepared monthly financial statements and audit workpapers, general ledger account reconciliations, and variance analysis, participated in special projects, involving due diligence work such as mergers and acquisitions. Jeff has successfully completed mediation on numerous PRRB cases.

As a consultant in our Rural Health/Critical Access Division, Jeff has worked with numerous clients on Rural health Clinic analysis and conversions and Provider Based status. He works with these facilities to ensure that they are optimizing the opportunities their special designation offers.

Jeff graduated from the University of Michigan, School of Management, with a Bachelor of Business Administration. He is a current member of Great Lakes Chapter of the Healthcare Financial Management Association.

Keith Poniers

Keith has over fifteen years of financial and accounting experience. During this time, he has developed an expertise in all facets of accounting, including corporate budgeting, negotiations with financial institutions, accounts receivable and account payable functions.

Keith's experience includes oversight of all financial aspects of a rapidly growing manufacturing corporation; responsibility for financial control and reporting, financial analysis, forecasting, cash flow, and annual and long-range planning. He prepared and analyzed monthly journal entries, financial statements, and financial ratios, and performed assessment on capital expenditures.

More recently, Keith's accomplishments include cost report preparation and review, department feasibility studies, financial analysis, third-party audits, appeals and preparations of reports and special payment requests filed with third-party payors. He works with providers nationwide on reimbursement and regulatory related issues.

As a consultant in our Blue Cross Division, Keith focuses on identifying improved reimbursement opportunities for our clients. He has performed multiple Blue Cross Blue Shield reimbursement analyses and model reviews.

Keith received his Bachelor of Science degree in Business Administration from Indiana University, majoring in Accounting. He is a member of the Eastern Michigan Chapter of the Healthcare Financial Management Association.

Gregory L. Murray, MBA

Greg has over 25 years of experience as a healthcare financial management professional working in various large Michigan hospitals. He offers our clients innovative problem solving capabilities and the ability to link business strategies to successful outcomes. Greg's competencies include Third-Party Reimbursement, Corporate Compliance, Strategic Planning, Financial Analysis, Budgeting, nonprofit tax knowledge and Decision Support.

Greg has served as the Director of Financial Planning for a large multi-hospital healthcare system with responsibilities for reimbursement, operating and capital budgeting and financial analysis. As a Financial Consultant for a joint venture Radiation Oncology Center, his involvement included start-up, obtaining bond financing, and managing financial operations. In addition, he served as a financial consultant for a successful low income health plan, developing financial systems and acting as the Chief Financial Officer.

Over the years, Greg has managed and directed the financial operations from both the Home Health & Hospice and Durable Medical Equipment companies within a large healthcare system with responsibilities for revenue cycle, cost reports, budgeting, analysis and compliance. He developed, implemented and directed a system-wide corporate compliance program for a larger healthcare system, including multiple joint ventures. This included, developing and implementing compliance policies, HIPAA privacy regulations and EMTALA, reviewing physician contracts for compliance reports for the Board and Corporate Office. Greg was financially involved in the merger and closing of four hospitals, the opening of a new medical center and the formation of a new healthcare system. He has worked to ensure heealthcare system compliance with IRS regulations and corporate taxes (corporate IRS returns) for a large healthcare system, involved with both FASB 109 and FIN 48 projects.

Greg's focus is in the Medicaid arena, reviewing Medicaid Disproportionate Share Hospital pools, and cost reports, working with facilities to optimize reimbursement. His expertise will assist facilities in relation to payor contractual calculations.

Greg is currently a member of the Health Financial Management Association (HFMA) and the Health Care Compliance Association. He is a former recipient of the Follmer & Reeves Award from HFMA.

Stephen C. Sprague, CPA

Stephen has over seven (7) years of experience working in financial analyst positions across multiple markets. During this time, he has developed an expertise in all facets of accounting, including corporate budgeting, financial reconciliations, and financial reporting. His experience includes multiple years as a Corporate Controller for a national business strategy organization.

Additionally, Stephen's previous experience includes working as an auditor of a large regional accounting and business consulting firm, focusing on audits, financial statements and other assurance services for clients in a variety of industries. He also worked as an Internal Controls Analyst, focusing on obtaining quarterly certification of financial results and internal controls in accordance with the Sarbanes-Oxley Act of 2002, coordinating testing and remediating deficiencies identified, and assisting in the approval of programs as qualified restructuring expenses. Stephen has managed several special protects over the years, including the conversion of an accounting system.

Currently, Stephen serves as a consultant on our Low Volume Adjustment (LVA) team, working with hospitals nationwide to take advantage of this reimbursement opportunity. He has participated in the completion of LVA requests for Sole Community and Medicare Dependent Hospitals. He also assists clients with third-party appeals, and cost report structure reviews to ensure all reimbursement opportunities are optimized. As a consultant in our LVA Division, Stephen focuses on identifying improved reimbursement opportunities for our clients.

Stephen holds a Masters of Accounting degree from University of Michigan and is a current member of the Great Lakes Chapter of Healthcare Financial Management Association.

Herbert Bruss, (RT)R, MA

With over 35 years of healthcare experience, Herb has rejoined The Rybar Group team as the Manager of our Data Quality and Compliance Department. Through this role, Herb will focus on developing long-term relationships with clients while providing superior communication and expertise on reimbursement and compliance related issues.

Herb brings to The Rybar Group over five years of experience in consulting, having worked with clients on various engagements related to the Charge Capture Process and compliance related engagements. He has worked on several successful Charge and Description Master assessments, as well as performed a multitude of Quality Reviews, assessing for appropriate documentation, coding and reimbursement for outpatient and professional services. Through his efforts, he assisted healthcare facilities in recovering lost charges due to errors in billing and ensured that their activities were compliant with Federal and third-party payor regulations.

Prior to becoming a consultant, Herb spent twenty-two years working in Diagnostic Imaging. Thirteen of these years were spent in an administrative role. This time was spend working with operating and capital budgets, service as a member of the Quality Management Team and Chairing the Operational Performance Improvement Committee for a large health center. He oversaw and participated in successful JCAHO and MQSA Mammography inspections in multiple states. In addition, he developed a Quality Assurance Program that became the model for the Radiology Departments of regional facilities of a large health system.

As a consultant and former technologist, Herb brings extensive experience and knowledge to assist healthcare professionals with operational, compliance and technical issues. Herb has done extensive work with Charge Capture related issues and financial reimbursement and has a proven track record in re-engineering different areas of the Hospital that resulted in cost savings and compliance.

Herb is an effective communicator, providing educational seminars related to reimbursement and compliance. He has spoken at national conventions for both the American Health Information Management Association (AHIMA) and the American Healthcare Radiology Administrators (AHRA).