PDPM Case-Mix Optimization
PDPM payment is driven by 5 case-mix components — PT, OT, SLP, Nursing and NTA — each derived from MDS coding. Under-capture of any component directly reduces the per-diem rate. We validate MDS-driven case-mix categories against clinical documentation.
- MDS Section GG functional scoring validation
- NTA comorbidity capture review
- SLP-related comorbidity identification
- Variable per diem (VPD) day tracking
Dual Part A and Part B Billing
While a resident is in a Part A stay, certain ancillary services may still bill Part B — and the rules around what's bundled vs. separately billable are exactly the kind of detail that creates revenue leakage when handled inconsistently.
- Part A consolidated billing compliance
- Part B billing for non-bundled services
- Therapy minutes documentation alignment
- Hospice-related billing exclusions
Long-Term Care AR Management
Medicaid LTC AR moves on monthly cycles with state-specific billing windows and patient-liability reconciliation. We manage state-by-state Medicaid follow-up plus managed-care plan AR on payer-specific cadence.
Operational Challenges We Solve
- PDPM case-mix categories suppressed by MDS under-coding
- Part A/B billing crosswire causing duplicate denials
- Medicaid patient-liability reconciliation errors
- Managed care plan authorization gaps mid-stay
- Therapy minutes documentation insufficient for billed level
- Triple-check meeting findings not reaching billing
Discuss Your Organization's Needs
Speak with a specialist about how our RCM workflows adapt to billing services for skilled nursing facilities.
Contact Our Team