PDPM is complex. Proactive’s MDS coding and documentation experts provide the coaching and validation services you need to succeed under PDPM.

• • QA AUDITS: Our proven audit program drives coding accuracy to capture the patient-centered care you’re providing to ensure proper Medicare Remote MDS validation audits, therapy medical necessity audits, and skilled documentation reviews drive proper payment and medical review success.
  • EDUCATION: Skilled documentation training, MDS orientation, ICD.10-CM training and RAC-CT/RAC-CTA Certification Training as an AAPACN training partner is available
  • COMPLIANCE SUPPORT: Medicare compliance and PDPM operational process improvement consulting

Proactive provides comprehensive Medicare Program compliance analysis through a combination of remote and onsite review of systems, interdisciplinary supportive documentation, coding, Utilization Review and Triple Check processes, SNF PEPPER data, medical review history, functional outcomes and other key performance indicators

Proactive’s AAPACN certified MDS nurse consultants offer the support your team needs to achieve your clinical assessment, coding and reimbursement goals. Services include:

• • MDS Orientation programs
  • Coding support partnerships
  • Remote MDS department oversight including ongoing monitoring for optimal CMI and QM accuracy with annual support work plans available
  • Interim MDS staffing
  • Learn more

Medicaid CMI review services to drive Medicaid payment accuracy

Proactive’s reimbursement experts assist post-acute providers through:

• • Program evaluation and systems review
  • Policy and procedure development
  • Coding and documentation audits
  • Education and training
  • Risk Management

Proactive assists in effectively responding to medical review to reduce error rates during government investigations and payer audits. Proactive Consultants offer:

• • Complete ADR and Appeals management services including preparation of medical record submissions at each stage of medical review and through the Medicare appeals process.
  • Proactive represents post-acute providers at ALJ hearings
  • Training and systems development support is available to remedy areas of concern identified during medical review
  • Compliance investigation support

Proactive’s extensive medical review experience includes FCA investigation support, as well as successful outcomes with reduced overpayment liability for providers involved in RAC, UPIC/ZPIC, MAC and commercial payer reviews. Learn more