Clinical Reimbursement & Quality Reporting
Despite the inexorable transition to “value-based purchasing,” per-diem (fee-for-service) reimbursement systems remain the dominant payment mechanism for skilled nursing facilities. ZHSG ensures that the Minimum Data Set accurately reflects each resident’s clinical profile to secure the highest appropriate RUG scores that drive payment. While reimbursement optimization is essential, these efforts are for naught without a fully compliant support system to protect your revenue from subsequent audit.
Our reimbursement optimization program is fully scalable. Many facilities require only intermittent oversight to support their highly-competent internal reimbursement managers, while others benefit from daily consultant intervention to maintain appropriate payment rates. These engagements typically involve onsite visits; however, we can also work “remotely” by accessing the SNF’s Electronic Medical Records system. Remote access greatly reduces client expenses and allows for complete reimbursement-management outsourcing – anywhere in the country.
Providers must also be sensitive to their Quality Ratings, as referral sources “narrow” their post-acute networks and Medicare begins penalizing under-performing facilities. We support these efforts using advanced logic that enables our clients to achieve the highest possible 5-Star scores. Additionally, our related entities offer progressive solutions to reduce hospitalizations and improve Quality Measure performance.
ZHSG’s Clinical Reimbursement & Quality Reporting services include:
- Acuity-based / RUG Optimization (Medicare and Medicaid CMI)
- Comprehensive MDS / Documentation Support
- Clinical Program Development
- Quality Reporting Analysis and Enhancement
- Full-Spectrum Audit Defense (MAC, RAC, ZPIC, OMIG, OIG)
- Diverse Training Curriculums and Management Resources
- Outsourced Reimbursement / MDS Management
- Value-Based Purchasing Metric Monitoring and Support