Next Generation Analytics

The Medicare claim (UB-04) has been overlooked as a powerful SNF analytics tool since the MDS gained primacy under PPS.  PDPM has changed this dynamic.  The Medicare claim’s diverse item-set is distinct from the MDS or medical record, and as such offers unique insight into provider and market dynamics – Z-CORE Analytics (or CORE) was created to unlock this potential.

CORE currently services approximately 2,500 SNFs in 49 States and Washington DC.  Providers submit Medicare and Medicare Advantage claim files to CORE prior to billing the MAC or insurance companies to identify “lost” patient-specific revenue opportunities.  These errors and omissions are then rectified on the associated MDS during the month-end triple check process.  The average “hard ROI” on the patient-specific “logic test” review is 9:1. The new assessment completion process for PDPM with one assessment controlling payment for up to 100 days, costs the facility thousands of bottom-line dollars if just one minor coding error is made.

The claim is also an asset in terms of understanding market dynamics and demonstrating the SNF value proposition to “at risk” stakeholders.  The challenge is that Medicare claims data released by CMS, which is included in CORE at no fee as a value-add, is often 9 months old and lacks the granularity necessary to glean actionable insights; but the most troublesome aspect of relying on such old data is COVID distortion – 2021 performance is not an approrpiate period against which to benchmark “Value.”

SNF-level Medicare Advantage data simply does not exist.  Insurance companies are not required, and certainly not inclined, to release utilization data; with enrollment approaching 50% of eligible beneficiaries, the industry is left relying on outdated metrics from half the population.  This is unacceptable in a reform-driven, data-centric, risk-based world.

CORE solves these challenges by leveraging current-month data to deliver meaningful, relevant insights – all clearly quanitifed on our Value Based Post-Acute eXchange (VPAX) and Medicare Advantage Post-Acute eXchange (MAPAX).

CORE is a stand-alone system that requires no technology integration.  SNFs simply upload claim files to CORE as they would to Medicare and Medicare Advantage plans.  There are no onboarding costs, no cancellation fees, no contract lock-in burden… and no more than 30 minutes needed to rationalize reimbursement and performance metrics.