Facility Management vs. Benchmarks performance
Reimbursement Audits: Reimbursement Audits can assure that the facility meets all requirements to ensure proper payment for all payer types, including State and Federal programs, and all supporting documentation is present and appropriate. Audits include a review of work processes to increase facility efficiency and accuracy. Identification of risk areas hindering financial solvency is a major focus.
PPS Management Evaluation: Review of medical record documentation to ensure accurate MDS coding, UB04 review (with comparison to the medical record and MDS), review of denial notices, certifications, and other required documentation to support Medicare billing. Review of work processes to increase facility efficiency and accuracy.
Managed Care: Including managed care review, medical record review, appeals review, and review of contract requirements and medical record documentation to support skilled services billed and expected, per contract level.
Supportive Documentation Review: Rehab, MDS, Nursing, Social Services, Admissions, Nursing Assistants, and others.
CMI Analysis: Including resident level case-mix indexing, as well as, overall facility CMI standings. Identification of “missed opportunities” and corrective measures to recoup revenue.
CMI Program Development and Management: Assistance with developing programs to track and improve CMI throughout the observation period and beyond, to ensure consistency in residents’ overall clinical status.
Eligibility and Benefit Verification and Pre-admission Screening for all payers: Assistance with the development of customized questionnaires and tracking forms.
Medicaid CMI Review: Chart audits for MDS accuracy related to RUG items impacting Medicaid CMI, including review of MDS management during picture window. Analysis of potential unrealized opportunities.