Gene Boron

Gene Boron is the President of Healthcare Reimbursement Resource Group
(HRRG).  He has over 30 years of progressive and diversified health care
experience in intermediary audit activity, hospital operations, Big Four public
accounting, and independent consulting.  He has extensive knowledge of the
Medicare laws and regulations; identifying and recovering "lost" reimbursement;
Medicare cost report appeals, to include resolutions with the intermediary,  
preparation of position papers, and representation before the PRRB; cost
report preparation, review, reopening, and resolution; SNF and excluded unit
requests for exemptions, exceptions and TEFRA rebasings; Disproportionate
Share Hospital (DSH) reimbursement; and hospital-based physicians.  During
HRRG’s initial six + years, he has recovered millions of dollars of
reimbursement through the discovery and resolution of providers'
reimbursement issues.

Prior to joining HRRG, Gene served as Director of Reimbursement for
a 598 bed medical center, which included psychiatric and rehabilitation
excluded units, skilled nursing facility, kidney transplant unit, home
health agency, renal dialysis unit, hospital-based satellite clinic,
medical office buildings, primary-care physicians’ networks, hospice
program, pain clinic, and wound center.  During his four (4) years at
this facility, he was able to recover over $17,000,000 of
reimbursement through the discovery and resolution of prior periods’
and current cost report issues.

As a consultant with a major intermediary for three (3) years, he
prepared appeal position/resolution papers and other appeal
correspondence with providers and their representatives, the Provider
Reimbursement Review Board (PRRB), and BCBSA.  He represented
the intermediary at appeal hearings before the PRRB in Baltimore.  He
implemented the Graduate Medical Education (GME) regulations for
44 GME hospitals, which included six (6) hospitals affiliated with major
medical schools.

As Director of Reimbursement at a 300  bed facility for five (5) years,
he developed, implemented, and maintained a system of
reimbursement for all patient services, which increased payment from
federal, state, local, and private third party payors over $4,000,000.  
He managed physician practices, to include accounting, staffing, billing
and contract negotiations.  He performed feasibility studies regarding
the implementation of new services and ideas, as well as the
expansion, modification, and/or reduction of current services.

He was Manager of Field Audit Activity for eight (8) of his twelve (12)
years with a major intermediary.  He managed an audit staff of twenty
(20), who annually audited an average of 130 providers from a total of
325 providers.  As Audit Manager, he was the intermediary’s primary
decision-maker, problem-solver, and research source for the
resolution of material reimbursement audit and theory questions.

Gene graduated summa cum laude from St. Mary’s University, San
Antonio, Texas in 1966 with a Bachelor of Business Administration
degree with a major in accounting.  He was nominated to “Who’s Who
in American Universities and Colleges” and is a member of Delta
Epsilon and Kappa Pi Sigma honor societies.
Healthcare Reimbursement
Resource Group
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