About Us
Bay Area Healthcare Advisors, LLC (“Bay Area”) is headquartered in Annapolis, MD. We are a Delaware, LLC and provide healthcare entities reimbursement and regulatory solutions throughout the country. Our historic client base exceeds 500 healthcare entities.
The professionals at Bay Area can provide the greatest return on investment and insure regulatory compliance to your healthcare entity. The impact of our charge capture and revenue cycle services will benefit your entity within a 30 day period. Our professionals possess a minimum of 20 years of healthcare reimbursement, regulatory and clinical consulting experience. Our experience originates within healthcare organizations such as but not limited to: Academic Medical Centers, Hospitals, Physician Practices, Laboratories, Insurance Companies, Home Health Agencies, Long Term Care Facilities and Physical Therapy Groups. The diversification of our professionals is also made up of experience in working with International CPA and Consulting firms. Bay Area provides services to our clients that range from revenue cycle analysis to corporate integrity agreements.
Clients
Clients typically engage Bay Area to insure all services provided are billed accurately, efficiently and within third party guidelines. We accomplish this through one of our many revenue cycle or compliance related projects (e.g. Chargemaster Review, Revenue Cycle Assessment, Charge Capture Review, Medical Records Analysis, or Effectiveness Review).
Our average client size exceeds 600 million in gross revenues per annum and our typical findings related to our revenue cycle projects can be expected to net in excess of five (5) – ten (10) percent in net reimbursement for the period under review. Although, we benefit our clients financially through our analysis, our successes are also measured through resolving compliance related issues that may result in the reduction or avoidance of CIA's, punitive damages and retrospective non-voluntary reviews.
Regulatory Solutions 
Various clients request our professional services due to compliance related issues. Many clients, including law firms representing healthcare entities, request that we perform a review of the current Corporate Compliance Plan to insure that all federal requirements are being fulfilled regarding third party billing and corporate governance. This is a proactive approach to compliance and is highly recommended as part of an ongoing compliance plan. Other clients may currently be experiencing government or third party investigations. These investigations may result in a Corporate Integrity Agreement (CIA) which requires the election of an Independent Review Organization (IRO). We represent many healthcare entities as their IRO. We are experts in representation of clients under these stringent self reporting requirements and have been successful in negotiations on behalf of our clients to reduce the terms of these agreements.
Revenue Cycle
Bay Area’s Revenue Cycle Charge Capture projects includes substantive testing in the form of inquiry, medical records review, chargemaster review and charge analysis of the following hospital areas:
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Our Revenue Cycle consulting services provides assessments and solutions for the most problematic areas within your revenue cycle. Our projects mostly include working in the following hospital areas:
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To understand our approach and objectives in these areas please review our project fly sheet
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Pharmacy Benefit Management (PBM) Services
Bay Area continues to develop and enhance our Pharmacy Benefit Management projects which have saved insurance companies and self funded health plans tens of millions of dollars through our consulting expertise. The savings originate from our audit tool, RxAnalyzer™ and always result in successful outcomes on behalf of our clients. The successes of our results are measured in expense reductions based upon the negotiations of new contractual terms with the Pharmacy Benefit Management Corporations. We believe that every contract we review or claim audit will result in significant savings for our clients. On average, we save our clients an estimated ten percent (10%) on their annual drug spend regardless of the current Pharmacy Benefit Management Contract.
We look forward to further communications with your organization and welcome open discussion regarding your needs as a provider of healthcare services.
Sincerely
James M. Cesare
President and CEO
Bay Area Healthcare Advisors, LLC