Clinical Reimbursement Consulting Services:

  • MDS Consulting– Our MDS and care plan experts will assess your organization’s performance and identify opportunities to enhance both financial and clinical outcomes, through both on-site and remote reviews.
  • Exception Reviews - For facilities in states that utilize exception reviews/Medicaid reviews, our consultants will help prepare your team to withstand these high-level audits. Documentation to support the services provided and in a manner that meets your state requirements is critical and will be the focus of our expert’s training and education.
  • PDPM - The Patient-Driven Payment Model (PDPM) for traditional Medicare A residents is a complex reimbursement model that must be fully understood to ensure your facility is being paid for the care they are giving. Our consultants will help ensure your team has the knowledge level and tools to be successful.
  • Medicare Part A or Part B Assessment - From corporate compliance initiatives to due diligence efforts, and also Corporate Integrity Audits, our MDS experts can evaluate risk levels associated with billed HIPPS codes versus medical record support. The outcomes of these reviews can provide valuable information to guide future training and education of your team members, with the goal of reducing risk.
  • Quality Measures: Our MDS consultants can evaluate, educate, and help create a plan of success in this far-reaching CMS initiative. Since QMs are associated with survey activity, Five Star calculation, Care Compare for consumers and referral sources, and reimbursement, your team must have the knowledge and understanding of each QM’s methodology and our experts can help get you there.
  • Customized Engagements - Different healthcare organizations have different needs. We have a team of nationally recognized consultants who are experts at addressing each client’s unique operational, financial and clinical challenges.

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