For more than 40 years, Toyon Associates has ensured that hospitals and integrated health systems maximize their Medicare and Medicaid reimbursements while maintaining compliance with government regulations. We are one of the few healthcare reimbursement consulting firms in the nation to offer comprehensive services from cost report preparation through appeals. Toyon Associates combines innovative technology with a passion for accuracy and a commitment to service excellence. Our proprietary software ensures accuracy and efficiency. Our teams of specialists combine hospital, public accounting, and intermediary based experience to create customized solutions within the most technical areas of Medicare and Medicaid reimbursement. In a world of constantly evolving regulations, it takes an expert to apply the latest federal mandates. Our teams of experts routinely exceed client expectations. Discover why our clients remain with us, decade after decade.
Thomas P. Knight brings more than 40 years of experience to Toyon Associates, Inc. Mr. Knight purchased Toyon Associates in 1992. Under his leadership the firm was transformed into one of the nation’s largest and most comprehensive healthcare reimbursement consulting firms.
Prior to acquiring Toyon Associates, Mr. Knight was founder and president of his own consulting firm. In addition, Mr. Knight served as principal and partner for the West Coast healthcare consulting division of KPMG Peat Marwick, an international public accounting firm. He also served as partner and co-founder of Knight & Carlson.
Mr. Knight’s extensive knowledge of Medicare and Medicaid stems from an early career as a provider reimbursement and audit manager for a Medicare fiscal intermediary. Qualified as an expert witness, Mr. Knight has testified before the PRRB on numerous occasions. An expert in Medicare appeals, Mr. Knight has successfully obtained millions of dollars of additional reimbursement for his clients.
As Chief Executive Officer, Mr. Knight provides the firm’s strategic overview, facilitating the creation of customized solutions. He is a graduate of University of California at Berkeley and holds an M.B.A. in Finance and B.S. in Accounting. Office: 888.514.9312
Ronald G. Knapp joined Toyon Associates in 1986 and has more than 40 years of healthcare finance experience assisting hospitals, integrated health systems and academic medical centers in the field of Medicare/Medicaid governmental reimbursement services. Mr. Knapp oversees Toyon’s overall operations and all service lines.
Mr. Knapp was also instrumental in organizing the software architectural group responsible for developing Toyon’s web and cloud-based proprietary cost report automation, workpaper storage and business analytics tool entitled Absolute®.
For the past 35 years, he has been part of Toyon Associates’ executive leadership, facilitating the firm’s growth from a staff of 3 to greater than 70 regulatory and reimbursement professionals. Toyon has grown to be the largest Medicare/Medicaid regulatory and governmental reimbursement consulting firm in the country. As one of Toyon’s senior experts in Medicare/Medicaid reimbursement strategies, Mr. Knapp continues to advise hospitals and healthcare systems.
Prior to joining Toyon Associates, Mr. Knapp was in industry and held Reimbursement Director positions at two large medical centers. He is a graduate of California State University and holds a bachelor’s degree in accounting. Office: 888.514.9312
Ryan Sader has more than 15 years of experience in the healthcare industry, including regulatory reimbursement and hospital accounting practices, accounts receivable valuation and contractual allowance modeling. Mr. Sader serves as Toyon’s Medicare wage index and occupational mix national service line leader. Recent wage index studies in California, Oregon, Washington, Minnesota and Hawaii yielded additional reimbursement well over $300 Million.
Mr. Sader also led the California Rural Floor wage index strategy services, as well as Medicare occupational mix survey preparation and optimization and Medicare geographic reclassification applications for hospitals and counties throughout the western United States and South Carolina.
Mr. Sader is the Chief Financial Officer (CFO) at Toyon Associates.
Prior to joining Toyon, Mr. Sader worked for a Big 4 accounting firm, performing financial audits for hospitals, health systems and academic medical centers.
Mr. Sader is a Certified Public Accountant (CPA), licensed in California, and a member of the California Society of CPAs and American Institute of CPAs. He is an active member of the Healthcare Financial Management Association. Mr. Sader is a graduate of University of San Diego, with master’s and bachelor’s degrees in accounting. Office: 888.514.9312
Public Hospital Services
Carrie Yee brings more than 25 years of healthcare experience to Toyon, including from both industry and professional services/consulting perspectives. Ms. Yee currently serves as Toyon’s national service line leader of Public Hospital Services. She maintains a close relationship with the California Association of Public Hospitals (CAPH) that enables her to closely monitor new programs and be proactive in apprising and educating clients about these programs.
Prior to Toyon, she spent 13 years as the Director of Revenue and Reimbursement for El Camino Hospital in California, overseeing a team of five, with full responsibility for leading all revenue recognition activities for more than 100 hospital departments, managed third-party reimbursements and audits, cost report filings and appeals, OSHPD reports, and contractual adjustments. Additionally, she oversaw yearly price increases in charge master, performed clinical trial revenue studies, and prepared all financial statements. Ms. Yee was also a reimbursement manager for UCSF Stanford Medical Center and a Medicare Auditor for Aetna.
Ms. Yee is an active member of the Healthcare Financial Management Association (HFMA). She is a graduate of the University of California – Davis with a Bachelor of Science in Managerial Economics.
Daniel Pelayo has more than 15 years of experience helping hospitals, health systems and academic medical centers preparing, reviewing and analyzing Medicare and Medicaid cost reports. Mr. Pelayo currently oversees the design, development, and marketing of Toyon’s proprietary cost report automation software called Absolute® and leads Toyon’s Innovation team, managing a blend of internal data scientists and software architects to tackle industry challenges leveraging the latest technologies.
Mr. Pelayo previously managed Toyon’s cost report service line, overseeing the preparation of more than 130 Medicare Cost Reports and greater than 60 California OSHPD disclosure reports annually. Mr. Pelayo has also provided Medicare and Medicaid audit assistance, has taught various cost report preparation training sessions, and continues to provide regulatory and reimbursement guidance to several hospitals and health systems of all sizes.
Mr. Pelayo is an active member of the Healthcare Financial Management Association (HFMA). He is a graduate of the University of California, Santa Barbara, with a degree in Business Economics with emphasis in accounting.
Fred Fisher has more than 20 years of healthcare experience identifying, managing and compliantly reporting on Medicare and Medicaid regulatory reimbursement policies for hospitals across the country, including uncompensated care, disproportionate share hospital, wage index and occupational mix, value based purchasing design, and CARES Act tracking, reporting and compliance.
Mr. Fisher specializes in the development of provider financial impact modeling and analytics, solutions, and opportunities associated with new and proposed state and federal regulations. During the public health emergency (PHE), Mr. Fisher lead Toyon Associates’ effort of developing, building and updating a CARES Act data management workbook to aid hospitals/healthcare systems track and maintain compliance with the Provider Relief Fund (PRF) requirements. He further led virtual workgroups comprised of health systems across the country in discussing and interpreting the vast and ever-changing regulatory guidance published related to the PRF.
Prior to the PHE, Mr. Fisher was Toyon’s national service line leader for Uncompensated Care Recognition Services, assisting hundreds of hospitals compliantly report charity care and bad debt to the Centers for Medicare and Medicaid Services (CMS)
Prior to joining Toyon, Mr. Fisher was Vice President of Finance for a safety net hospital association in the northeast. In this role, Mr. Fisher frequently engaged with legislators regarding funding for uncompensated care, graduate medical education, and population health initiatives.
Mr. Fisher is an active member of the Healthcare Financial Management Association. He is a graduate of Rider University with a bachelor’s degree in management and operations.
Karen S. Kim brings 20 years of professional experience to Toyon, 10 years of that in healthcare law, assisting hospitals, health systems and academic medical centers interpret and navigate complex reimbursement regulations and secure and preserve dollars to which they are entitled. She serves as Toyon’s national service line leader for Appeals Services, which assesses audited cost reports, identifies viable appeal issues, and represents providers through the appeals process both at the administrative agency level and in federal and state courts to help providers maximize their federal and state reimbursement(s). Federal and state legislation relating to cost report reimbursement and audit appeals has become increasingly more complex, with rigorous deadlines and requirements, and a failure to understand and navigate these procedures properly can cost providers hundreds of thousands to millions of dollars.
Prior to joining Toyon Associates, Ms. Kim was a healthcare law attorney, where she represented and advised healthcare providers with respect to litigation and compliance issues, including payment disputes with commercial managed care payors, Medicare and Medi-Cal provider appeals, Health Insurance Portability and Accountability Act (HIPAA) compliance, anti-kickback statute compliance, and Stark Law compliance. Prior to becoming an attorney, Karen served as Press Secretary to the California Assembly Majority Leader and former Assembly Health Committee Chair and worked as a reporter for the community news division of the Los Angeles Times.
Ms. Kim is an active member of the Healthcare Financial Management Association (HFMA). She is a graduate of the University of California – Davis Law School, with a Juris Doctorate degree and Northwestern University Medill School of Journalism, with a Bachelor of Science in Journalism.
Lloyd Haggard has more than 30 years of experience helping local and regional hospitals, integrated health systems, and academic medical centers improve and sustain organizational performance through Medicare and Medicaid financial, regulatory and reimbursement consulting services. He also has significant experience supporting merger and acquisition projects performing due diligence and compliance analyses. Mr. Haggard has both provider and professional services/consulting experience.
Prior to joining Toyon, Mr. Haggard worked for a National professional services firm and two Big 4 accounting firms and was previously the southwest geographic lead for reimbursement services. He has extensive knowledge and experience consulting on reimbursement issues, including disproportionate share and uncompensated care, Medicare bad debts, strategic pricing and provider-based vs. freestanding clinic analyses. Recently, he performed a comprehensive evaluation and analysis related to a large metropolitan area health system’s provider number structure to support the health system’s mission and goals, reporting structure and geographic location.
Mr. Haggard is a Certified Public Accountant (CPA), licensed in Oklahoma and Arizona, and a member of the Oklahoma Society of CPAs and American Institute of CPAs. He is an active member of the Healthcare Financial Management Association. He is a past president of the Oklahoma Chapter, served as a Regional Executive for Region 9, and is past chair of HFMA’s national Chapter Advancement Team. Under HFMA, he is a Fellow of HFMA (FHFMA) and a Certified Healthcare Financial Professional (CHFP). He is a Certified Professional Coder and member of the American Academy of Professional Coders. He is also a Chartered Global Management Accountant (CGMA). Mr. Haggard is a graduate of Missouri Southern State University, with a bachelor’s degree in accounting.
Mark Nichols has more than 30 years of experience in the healthcare industry. He has an extensive knowledge in finance and regulatory reimbursement with hospitals, health systems, and academic medical centers. Mr. Nichols specializes in providing corporate finance, revenue cycle and Federal and State regulatory related advisory services. He has significant experience in leading and managing operational and financial, regulatory compliance and due diligence consulting projects for health care providers, including disproportionate share (DSH) and uncompensated care (UCC), Medicare bad debts, transplant/organ acquisition, medical education and strategic pricing.
Prior to joining Toyon, Mr. Nichols was a Partner and Managing Director at two Big 4 accounting firms where he was the National Lead for the DSH/UCC service line. He also served as the Quality Review Director for regulatory and reimbursement services.
Mr. Nichols is a Certified Public Accountant (CPA) licensed in Florida, New York, and Tennessee. He is an active member of the Healthcare Financial Management Association, American Institute of CPAs, and Florida Institute of CPAs. Mr. Nichols is a graduate of Saint Thomas University, with a bachelor’s degree in accounting.
“I truly feel that Toyon’s Absolute® will make your reporting more efficient…once you begin working with Absolute, you’ll wonder how you ever worked without it. Absolute also eliminates the annoyance of not being able to find support for work papers because your analysts can easily upload them to Absolute and attach to the applicable sheet.”
“Toyon consistently delivers forward-thinking, value-added results with exemplary customer service. Over the years we have brought in Toyon for help across the reimbursement spectrum, ranging from meeting annual regulatory requirements to executing on special projects that have added material dollars to the bottom line. From beginning to end on each project, our entire team, from staff to executive, has felt 100% taken care of.”
“When tasked with standardizing and centralizing our government reporting process…I partnered with Toyon for their deep technical resources and Absolute, their automated workpaper system. Toyon helped us move from individual facility data collection to a single shared services center. The result…cost reports completed on time and on budget, audit adjustments had virtually disappeared, and the system had achieved annual reimbursement improvements in the $10s of millions.”
“We have worked with Toyon on a variety of projects over the years and they have become an important and trustworthy part of our team. We use their Absolute product at many of our facilities and it is truly best in class.”
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