Coding, billing, documentation, and compliance review
A sample of notes, codes, and remittances, read the way a buyer will have to live with them.
Learn moreDue Diligence
Reimbursement and compliance review for healthcare transactions.
Price is a story about future cash. In a healthcare deal, that cash sits on coding, contracts, and statutes a general diligence memo can skip. The firm reads the revenue cycle the way a buyer or seller will have to live with it.
Reviewed by Joseph Rivet · September 29, 2026
The Challenge
Look at the claims, not only the policies
A clean compliance manual can sit next to a code that does not match the note. Diligence samples the work product: encounters, remittances, refunds, and the people who touch them.
Stark, anti-kickback, and HIPAA issues in a transaction
Compensation, referrals, and health-information practices that can change the deal.
Learn moreRisk that affects escrow and purchase price
Open audits, refunds, and unbooked takebacks that belong in the price conversation.
Learn moreReview of revenue cycle and health information roles
Who will run coding, billing, and privacy after close—names, not vendor logos.
Learn more
Who We Help
Who this work is for
Diligence here is done by people who have seen how a chart becomes a claim. Stark, anti-kickback, and HIPAA issues are easier to spot when you already know what a messy encounter looks like in the billing system.
- Buyers who need a reimbursement read before price is locked
- Sellers who want surprises found in the data room, not after close
- Investors and outside counsel who need a specialist on the diligence team
- Groups whose value is mostly professional collections
Our Process
First steps you can take today
These steps organize the file. They are not a substitute for counsel.
- 1
Identify the top payors and the top ten codes by collections.
- 2
Ask for open audits, refunds, and any self-disclosure in the last three years.
- 3
Map who owns coding, billing, and privacy after close—names, not vendors.
- 4
Flag any compensation formula that looks like a volume bonus tied to referrals.
Look at the claims, not only the policies
A clean compliance manual can sit next to a code that does not match the note. Diligence samples the work product: encounters, remittances, refunds, and the people who touch them.
Concentration risk matters too—one payor, one code family, one provider whose production is the deal. Those facts belong in the price conversation early.
What changes the escrow
Open audits, self-disclosures, and refund obligations that were never booked are the usual price adjustments. So is a vendor contract that leaves the buyer answering for the seller’s claims.
The useful deliverable is a short list of items that should move money or require a covenant—not a 80-page restatement of every regulation that might apply.
Common questions
- When should reimbursement diligence start?
- Before the letter of intent locks a price that cannot move. A week of claim sampling is cheaper than an escrow fight.
- Is this a substitute for corporate or tax diligence?
- No. It sits beside that work. The firm’s scope is coding, billing, payor contracts, and the healthcare statutes that attach to how the target gets paid.
800 E. Ellis Road, Ste 515, Norton Shores, MI 49441
(231) 799-4870
info@rivethealthlaw.com
rivethealthlaw.com
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Diligence red flags
8 itemsAsk for these before the price is final
If a seller cannot produce an item, that absence is information. Use the list in the data room; it is not a finding.
Check items off as you collect them. Your progress is saved on this device.
This sheet is a gather list for your own file. It is not legal advice.
When you want help
Bring the letter, the remittance, or the agreement.
If the first steps on this page raised a question, the firm can sit with the file.
This page is educational. It is not legal advice and does not create an attorney-client relationship. Facts, contracts, and appeal windows control the next step.