Tony Whelan is a financial healthcare expert with nearly 20 years’ experience leading healthcare financing and regulatory efforts. Throughout his career he has enhanced his knowledge and honed his skills related to healthcare management, financial analysis, reimbursement, consulting and auditing for clients and partners.
Tony’s scope of service includes cost reports for a wide range of facilities, including acute care hospitals, home offices and rural health clinics as well as contractual adjustments, uncompensated care payments, cost report re-opening and appeal request, and hospital consolidation analysis.
Prior to joining HMA, Tony spent two years with RSM and nine years at PricewaterhouseCoopers (PWC), where his client-focused approach to reimbursement-related issues included cost report preparation and review, provider number analysis, due diligence, Medicare wage index and occupational mix reviews, third party settlements and reserve analysis, and Medicare appeals and contractual allowance reviews.
Tony’s efforts were not focused solely on processes, but also on innovation, developing models to assist clients with evaluation and financial analysis or opportunities, and issues related to Medicare/Medicaid provider changes specifically involving analysis or reimbursement.
Before working with PwC, he was instrumental in preparing presentations for formal adversarial proceedings before the Centers for Medicare and Medicaid Solutions, Provider Reimbursement Review Board (PRRB). This work, done while he was a consultant with the BlueCross BlueShield Association, included requests for hearings, filing jurisdictional determinations, drafting preliminary papers, review and analysis of final position papers and completing administrative resolutions on cases prior to board hearings. He also provided advisory assistance to plans on Medicare reimbursement issues and appeal procedures to ensure mandated appeal procedures were followed.
Tony earned a Master of Business Administration from Elmhurst College as well as a bachelor’s degree in accounting and business administration from Carthage College.