We treat yourfacilities likeour own.
Limestone is the solid ground under skilled nursing operators. CFO-level leadership and every layer of the financial back office, handled by one partner.
Our approach
Not a vendor.
A partner.
Most outsourced finance firms process transactions. Limestone takes responsibility for results. We learn each facility's people, payors and pressures, and manage its finances with the care we'd bring to a building we owned.
Individualized attention
No call centers, no ticket queues, no hand-offs. A dedicated team that knows your census, vendors, staff and numbers, accountable from the first invoice to the final close.
Your performance is ours
We measure our work by your outcomes: cleaner month-ends, faster collections, tighter spending and stronger margins. We don't just flag problems; we bring the fix.
An owner's mindset
Every recommendation is weighed the way an owner would weigh it, with your capital, your residents and your reputation in mind.
Our services
Eight layers.
One partner.
Take one department or the whole back office, for a single building or a multi-site portfolio. Open any layer to see exactly what's included.
Strategic CFO Advisory A senior financial executive working directly with ownership.
Brian Gopin
Founder & Managing Partner
Every Limestone client gains a senior financial executive working directly with ownership, at a fraction of the cost of a full-time hire. Brian's role doesn't stop at the facility's front door: he advises owners on every financial decision they face, whether it touches daily operations, the real estate, the capital structure or the next acquisition.
- Acquisitions & underwritingProformas, due diligence and operating projections.
- Financing & refinancingStructuring and lender negotiations for HUD, bank and bridge debt.
- Lender & covenant managementBorrowing base certificates and compliance reporting.
- Investor relationsDistribution planning and investor reporting.
- Tax & entity strategyPartnering with your CPA on structuring and year-end planning.
- Portfolio strategyBenchmarking across facilities to show where to invest.
Accounting & Financial Reporting Timely, accurate books you can run your business on.
- Month-end closeClose and adjusting entries, coordinated with your third-party partners.
- Full financial statementsTrial balance, balance sheet and P&L for both OpCo and PropCo.
- Bank reconciliationsMonthly reconciliations for every account.
- Ownership reviewsRegular financial reviews with ownership.
- Budgets and proformasBuilt side by side with facility leadership.
- Audit and tax supportAudit- and tax-ready records for your outside CPA firm.
Accounts Payable Vendors paid correctly and on time, always with your approval.
Whether you oversee a single building or a multi-facility portfolio, we help you avoid missed payments, overbilling and vendor disputes, so your team stays focused on operations, not paperwork. Available on its own or bundled, without giving up visibility or control.
- Invoice intake and trackingCentralized collection of every vendor invoice, with systematic tracking and storage.
- Charge verification and GL codingLine-by-line review of rates and quantities, with the right GL account assigned.
- Three-way matchingPurchase orders, packing slips and invoices checked against each other.
- Dispute managementDiscrepancies flagged immediately and resolved directly with the vendor.
- Payment processingCheck and ACH payments scheduled by terms and cash priorities, released only after facility sign-off.
- Local billsDirect coordination with your Business Office Manager.
- Vendor communicationTimely answers to vendor inquiries and complete payment records.
- Month-end AP aging reviewBalances kept current and vendor relationships strong.
- Spend reportingCustom reports by vendor, category or date range.
- Audit readinessOrganized, documented workflows and backup for internal or external audits.
Cash & Treasury Management Know your cash position before you need to.
- Rolling cash forecastsShared with your team so you can plan with confidence.
- Banking relationshipsBank account setup and relationship management.
- Investor distributionsProcessing and monitoring.
- Lender complianceBorrowing base certificates and covenant compliance reporting.
- PropCo obligationsDebt service and property tax payments.
- RFMS and reverse-ACHRFMS maintenance and reverse-ACH collection processing.
- Full cost captureCoordinated with your Medicare cost report consultant.
Payroll & HR Support Accurate pay, compliant reporting and a well-supported staff.
Payroll built for healthcare, where every paycheck has to reflect shift work, overtime, accruals and regulatory requirements. Whether you're outsourcing payroll for the first time or moving off a legacy system, we scale to your operation.
- Full-service payrollEnd-to-end processing for hourly and salaried employees.
- Wages and deductionsBase pay, overtime, shift differentials, bonuses, benefits and deductions.
- Time and attendance oversightPTO, sick and vacation accruals, holidays and missed punches.
- Pay deliveryDirect deposit or printed checks, delivered securely and on time.
- Tax filing and year-endPayroll tax calculation and filing, plus W-2 and 1099 preparation.
- GarnishmentsProcessing and ongoing monitoring.
- PBJ reportingPayroll-Based Journal submissions handled for you.
- Labor reportingPPD labor reporting and staffing budgets.
- OnboardingNew-hire onboarding in partnership with your HR Director.
- Systems and supportIntegration with timekeeping and scheduling platforms, training, and a dedicated support team.
Purchasing & Vendor Management Better pricing, reliable supply and less waste.
End-to-end procurement support that reduces administrative burden, enforces budget discipline and holds vendors accountable to their agreements. Pick only the pieces you need.
Purchasing & supply management
- Centralized procurementMedical, office, dietary, maintenance, laundry and housekeeping supplies.
- Group purchasing powerBulk ordering and GPO contract alignment to lower cost per unit.
- Order guidesStandardized, streamlined recurring purchases.
- Procurement portalOrdering, tracking and oversight for facility administrators and regional operators.
- Dietary oversightPurchasing for nutritious, cost-effective menus.
- Inventory and deliveryEssentials kept on hand, deliveries on time and accurate.
- Custom workflowsPurchasing workflows and approval chains tailored to each facility.
- On-site visitsRegular visits to every facility we support.
Contract review & negotiation
- NegotiationFavorable terms and real vendor accountability.
- Review and redliningAgreements checked for compliance and fairness.
- Pricing validationContract pricing terms verified against what you're billed.
- Lifecycle trackingOnboarding, exclusivity, renewal and termination dates monitored.
Invoice review & dispute resolution
- Invoice auditsPricing and service delivery verified against agreed rates.
- Dispute resolutionOverbilling resolved with vendors on your behalf.
- Approval workflowsGL code assignment and invoice approval routing.
- Accounting integrationApproved invoices flow straight into your books.
Compliance & survey preparedness
- Life Safety Code inspectionsIdentify NFPA and CMS compliance gaps.
- Mock surveysSimulated state and federal inspections.
- Action plansWritten reports and corrective-action plans.
- Survey coordinationWorking with facility leadership ahead of official surveys.
Billing & Revenue Cycle Every dollar earned is billed and collected.
A dedicated accounts receivable team of long-term and acute care billing specialists, working every account from initial billing through collections. Each facility is supported by people who understand its payor mix, its challenges and its goals.
- Census accuracyCensus reconciled across AR software, PCC and the facility.
- All payor sourcesMedicaid, Medicare and HMO billing, with every cash receipt posted.
- Claims follow-upTracking, follow-up and resolution of outstanding claims and denials.
- Admission documentationComplete and secured with Admissions and the Business Office.
- Aging reviewsReviewed with the facility, with active follow-up on non-payors.
- Medicaid PendingResidents tracked through to timely resolution.
Our goal: the highest possible collection rate, with payments received on time and accurately, in full compliance with every regulatory and billing requirement.
Reimbursement Services Securing every reimbursement dollar you're entitled to.
- Billing and collectionsAcross all payor sources for skilled nursing, assisted living and independent living.
- Triple-check reviewWith MDS, the Business Office Manager and therapy, so every claim goes out accurate.
- Aging reviewsWith Business Office Managers to drive collections and close open issues.
- Medicaid cost reportsPreparation, filing and review to maximize what you're owed.
- Enrollment applicationsMedicare and Medicaid applications set up and monitored through approval.
Our mission
To provide financial clarity, purchasing efficiency and operational support that enables our partners in healthcare to deliver exceptional care, without the administrative burden.
Who we are
Limestone Fiscal Services provides comprehensive financial and procurement solutions built for the long-term care and healthcare industry. We understand the operational challenges facilities face, and we deliver scalable support that lets our partners focus on what matters most: quality care.
Our team brings decades of experience in fiscal operations, contract negotiation and regulatory compliance, ensuring every client has a reliable back-office partner invested in their success.
Who we serve
- Skilled nursing & rehabilitation facilities
- Assisted & independent living communities
- Multi-site operators & portfolio owners
Choose your scope.
Engage Limestone for a single department or the full suite, and add services as you grow.
Predictable pricing.
A clear monthly fee per facility for each service you select. No surprises.
Proven platforms.
Sage Intacct, Stampli, Empeon, NCS, OnCare and Simple PBJ.
Let's break ground.
Schedule a conversation with Brian about where your buildings are today, and where they could be.