Medicare-PDPM Audit & Support Services
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
Medicare Program Risk Assessment
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
MDS Support Services
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
Medicaid CMI review services to drive Medicaid payment accuracy
SNF Reimbursement Compliance Consulting
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
Medical Review Support
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
Do we want to have a line here about regulatory services testimonials? Click here to read more testimonials.
The Heritage Center has worked with ProActive for many years. Our industry has been faced with many changes in regulation and reimbursement in the past 3-5 years. ProActive has been a valued part of our team to assist in guiding us through these changes. We are lucky to have a consulting partner with the expertise of ProActive’s team. We appreciate all the knowledge they bring to assist us in providing great, quality care! Their team is stacked with professionalism and expertise. They come highly recommended by the Heritage Center and we value our relationship with them immensely!
As leaders in the nursing home industry, ensuring the well-being and safety of residents is paramount. One of the most challenging aspects of this responsibility is investigating allegations of abuse and neglect within our facilities. In this article, we will explore...
Q: When is it appropriate to use staff interviews on the MDS? A: For the four interviews on the MDS (BIMS, PHQ2/9, Activities, and Pain), direct resident input should be the primary approach as observations may be misleading. For instance, the RAI manual...
Behavioral health issues in skilled nursing facilities (SNFs) require meticulous documentation to ensure proper care and compliance with regulations. Accurate documentation not only facilitates effective treatment but also helps in addressing legal and regulatory...