Educating & Connecting
-
Interface with community leaders and clients serving as content experts for reimbursement and revenue management of Medicare PDPM, Managed Care Organizations, and Medicaid.
-
Work directly with MDS Coordinators to enhance knowledge and skills to improve clinical outcomes, compliance, quality reporting, and correct coding
-
Provide education and auditing of reimbursement policies and procedures, including documentation, compliance, and operations
-
Providing custom data informatics intelligence to your existing nursing and rehab EMR.
-
Direct staff education and support for improved clinical outcomes, quality reporting, and accurate coding as outlined by the Resident Assessment Instrument (RAI).
Training
-
Patient-Driven Payment Model (PDPM) and Case-mix Index (CMI) performance review and strategies for improved compliance and revenue
-
Assist in developing an effective Resident Assessment Instrument (RAI) process
-
Managed Care and 3rd party contract reimbursement,5 Star, QAPI and Quality Measures (QMs)
-
Provide on-site support services, consultation, and recommendations for communities and clients, as requested
-
Consistent analysis of Case-mix Index (CMI) to efficiently manage patient costs, Five-Star, QAPI, and Quality Measures (QMs)
Compliance
-
Consult clients regarding compliance with policies and procedures as it relates to reimbursement systems to ensure compliance with managed care organizations (MCOs), federal and state programs
-
Conduct audits at communities to assure standards, policies and procedures are being followed
-
Remain informed regarding regulatory changes and consult in developing and implementing procedures for communities and clients to remain in compliance
-
Ensure client policies and procedures maximize resident outcomes, and reimbursement and maintains regulatory compliance for all state and federal programming
