Accounting firms deliver Quality of Earnings. Attorneys assess legal risk. Fulcrum Health Partners owns the Quality of Reimbursement — comprehensive reimbursement diligence that identifies hidden risk, uncovers EBITDA opportunity, validates payer relationships, and strengthens transaction confidence for buyers and sellers.
Most transactions evaluate financial statements without fully understanding the contractual and operational drivers behind future reimbursement performance. QofR fills that gap — sitting alongside every other diligence advisor.
Quality of Earnings & normalization
Corporate, contracts & risk
Structure & exposure
Regulatory & billing integrity
Systems & data
People & process
Quality & outcomes
Contracts, payment & future revenue
QofR evaluates whether a target's reimbursement is durable, scalable, and competitively positioned — and where future opportunity or hidden risk is concealed in the contracts. We evaluate, at minimum:
Deals move fast, and reimbursement documentation is often incomplete. Our long-standing national relationships with commercial payers and provider organizations let us access information many firms simply cannot obtain.
Obtaining missing payer contracts & historical amendments
Locating fee schedules & missing reimbursement exhibits
Clarifying reimbursement methodologies & validating contract language
Identifying undocumented payer relationships
Understanding payer-specific operational practices
Resolving reimbursement questions that stall a deal
Because of these relationships, we frequently obtain documentation and reimbursement intelligence that is unavailable through traditional diligence — on the timeline a live transaction demands.
Whether representing the buyer or the seller, we bring the reimbursement rigor that de-risks diligence and defends valuation.
Validate revenue quality and quantify the upside embedded in the reimbursement platform.
Surface and capture reimbursement upside — and package a buyer-ready diligence story.
Institutional-grade, decision-ready, and structured the way investment committees expect.
Move the sliders to reflect a target across ten reimbursement dimensions. The scorecard computes an overall QofR score with executive commentary.
Rate each dimension from 0 (poor) to 10 (excellent).
Model how pre-transaction rate improvement flows through EBITDA to enterprise value — and to the price a buyer will pay.
Adjust the assumptions — results update live.
Illustrative only. Rate improvements are modeled at a 90% flow-through to EBITDA. Actual outcomes depend on contract terms, payer mix, utilization, implementation, and market dynamics.
Deep reimbursement expertise wherever the deal is.
The difference between a diligence report and a value-creation outcome.
Quality of Earnings became a standard diligence workstream because earnings drive value. In healthcare, reimbursement drives earnings — yet it rarely receives the same scrutiny. Fulcrum is building Quality of Reimbursement into an expected component of every healthcare transaction, and serving as the reimbursement diligence advisor investment banks rely on nationwide.
Make QofR Part of Your Next Deal →Representing buyers or sellers, Fulcrum provides the reimbursement intelligence, payer expertise, and transaction support to improve diligence, reduce risk, uncover hidden value, and maximize outcomes.