Post-Acute Care Excellence

Proactive is an independent consulting firm specializing in post-acute care clinical excellence, regulatory and reimbursement compliance. Through our team of MDS certified nurses, therapists, and health facility administrators, we assist clients in achieving goals in the areas of 5 star survey, QAPI, compliance, audit readiness, and appropriate reimbursement.

Survey Management

Proactive provides expertise in Survey Management including:

• Mock survey
• Survey support
• Plan of correction development and implementation

Phase 1, 2, and 3 Requirements of Participation (RoP) Implementation

Proactive has Partnership Plans to guide your facility through the Requirements of Participation. We drive compliance alongside your team through a targeted work plan and tools to fill gaps in compliance including policy templates, facility assessment tools,, training resources, and program implementation. Contact us for information on our budget friendly consulting options.

Additional Resources

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Staffing

Survey

Quality Measures

Additional Resources

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Quality Assurance Performance Improvement (QAPI) Consulting

• Drive continual quality and care excellence by engaging Proactive’s QAPI certified practitioners to assist in enhancing programs and team skills to bring QAPI to life in your facility.
• QAPI plan development to meet Phase 2 Requirements of Participation (RoP)
• QAPI program policies, procedures and implementation assistance to meet Phase 3 RoP and drive 5 Star results

Additional Resources

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Complimentary QAPI White Paper

QAPI Toolkit

SNF Compliance & Ethics Program Services

• Compliance Program Development
• Compliance Training
• Hotline Monitoring & Investigations
• Interim Compliance Officer Services

Compliance Programs and Compliance Officer Support

Proactive’s Certified Compliance Experts can meet your needs for the development and ongoing implementation of a SNF Compliance and Ethics Program

Did you know?
The average healthcare Compliance Officer (CO) salary is $99,659.00? Proactive offers individual facility Compliance Program implementation and oversight solutions for a fraction of the cost of employing a full time CO.

Additional Resources

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3-Prong Approach to Reducing Denials

With therapist, billing, nursing and MDS specialists, Proactive is uniquely positioned to manage SNF claims reviews and investigations. Experienced help through ZPIC/UPIC, RAC, SMRC, MAC, CERT and insurance audits.

• Training and Audits – In-depth training followed by clinical documentation auditing
• ADR Management – Solutions for improved ADR payment outcomes
• Appeals – Complete appeals management and recoupment guidance

Additional Documentation/Development Request (ADR) Consulting

Proactive assists with implementation of effective medical review response systems to promote compliance and reduce errors resulting from government and other payer audits. Our ADR preparation services involve a thorough review of each claim by a clinical expert and an organized record is provided in a timely manner to the review entity. A clinical defensive position statement is drafted to clarify and highlight key information in support of the claim.

Appeals Management

Proactive Consultants develop a customized clinical appeal which focuses on payer policy, clinical standards and evidence based practice. The consultant represents the facility at each stage of the appeal process, up to and including the ALJ hearing.

Proactive partner clients currently maintain an exceptionally low payment error rate of 5% under medical review at the ADR level after using our comprehensive program of training, clinical program tools, ongoing audits, and medical review response services. Proactive has historically overturned 93% of denied claims on appeal.

Proactive has had significant success in reducing overpayment liability for providers involved in ZPIC, UPIC and RAC reviews.

Medical Review can be overwhelming. Proactive can help. Our proven system yields improved payment outcomes under Medical Review.

Additional Resources

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SNF Risk Assessment

PDPM Support Services

Proactive’s MDS coding and documentation experts provide the coaching and validation services you need to succeed under PDPM. Let us assist you in coding accurately to capture the patient-centered care you’re providing to ensure proper Medicare reimbursement. PDPM Support Services include remote MDS validation audits, supportive documentation and coding training, and PDPM operational process improvement consulting. Facility specific projects and annual partner work plans are available. Proactive consultants are knowledgeable in the critical elements of MDS coding, SNF ICD.10-CM, systems of IDT clinical collaboration and reimbursement/billing compliance to assist your facility in developing PDPM expertise.

Download our “Understanding the Patient Driven Payment Model (PDPM)” here.

Download a printable PDPM Coding Support Solutions Information Sheet here.

Reimbursement Review

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MDS Systems Audits

• PDPM Coding and Documentation Audits
• MDS Data Integrity Audits
• MDS Training and Education
• MDS Systems Development and Management
• Medicare Program Compliance Audits
• Medicare Eligibility Reviews
• MCR and MDS Supportive Documentation Reviews
• Case Mix Reviews
• Mock Surveys
• ADL Coding Training and Auditing
• Medical Review Response
• Orientation of New MDS Staff
• Short-term Interim MDS Staffing

RAI Training and Education

• ADL Coding Training
• Orientation of New MDS Staff
• Medicare and MDS Supportive Documentation Training
• Person-Centered Care Planning
• ICD-10 Coding
• Restorative Nursing Programs

Documentation and Coding & Billing Validation

• Targeted Medical Record Auditing & Monitoring
• MDS Coding Accuracy
• Reimbursement Compliance
• Review of 1135 Waiver Application
• Physician Certification
• Contract or in-house therapy support and chart audit service

SNF Rehabilitation Stay Quality Assurance

Proactive offers medical record documentation reviews with emphasis on overpayment risk and current industry audit activities. An objective 14-point scale audit with individual clinician feedback highlighting examples of compliance in supporting care and coding, opportunities for improvement, and feedback on the active treatment course progression.

Additional Resources

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Rehabilitation Support & Oversight

• Therapy support and management services for in-house programs
• Rehabilitation auditing specializing in Medicare A, B and Insurance reviews for SNF Providers, TCU/Swing Bed Units, and Outpatient Therapy Clinics
• Rehabilitation Clinical Programs
• Coding & Documentation Training
• IRO/Skilled Service Oversight & Monitoring

Let us put our experience in driving quality to work for you!

Contact us today to learn more about our services which are reasonably priced by the hour, project, or as part of an annual partnership plan.