Medicare Compliance Operations Assessment. The Polaris Group's Medicare Compliance Operations Assessment provides you with a tool to evaluate key systems organization-wide that could impact Medicare compliance and related revenue. Polaris Group consultants will evaluate your systems related to nursing, MDS, case management, therapy, billing, and ancillary vendor contracts; identify opportunities to improve revenue, decrease cost, and reduce compliance risk for denials; and provide detailed report with Risk Scores and recommendations.

Medicare & PDPM MDS Accuracy Audits provided onsite and offsite to ensure accurate revenue and compliance with Medicare.

• Onsite or Offsite Medicare and PDPM MDS accuracy check
• PDPM Training
• ICD-10 Training
• GG Coding Training
• Compliance with Medicare rules related to MDS timing, Interim Payment Assessment, and Interrupted Stay
• MDS management to obtain accurate PDPM reimbursement
• Compliance with Medicare eligibility and continued stay requirements
• Compliance with physician certification and notification of non-coverage requirements
• Audit the quality and consistency of skilled nursing documentation to support a continued stay
• Communication and case management systems with therapy and billing
• Restorative nursing services support of Part A and B
• Quality assurance activities related to requirements

Unplanned Hospital Admissions Review

Length of Stay and Unnecessary Hospital Admissions:
Provide analysis  of discharges to hospitals within 30 days of admission; identify strategies to increase LOS and unnecessary re-admissions; training for nursing staff is included.

Polaris Group will provide offsite or onsite assistance with identifying unplanned hospital re-admissions by:

• Providing analysis of root cause for transfers back to hospital within 30 days
• Identifying preventable causes/transfers and create strategic solutions
• Training nurses to communicate effectively with physicians
• Improve pre-admission screening process
• Provide tools to assist with communication and tracking

Offsite or Onsite in-services to staff include:

• Impact on your LOS
• Scope of problem
• Why re-admissions occur
• Strategies to prevent
• How to manage change in condition

• Therapy documentation to support skilled service
• Therapy compliance with Medicare requirements
• Therapy productivity
• Communication and case management systems with nursing
• Part B services and utilization

• Billing Revenue Management
• UB04 accuracy audit
• Compliance with Medicare regulations
• ADR and denials management procedures
• Part B billing
• Accounts receivable and payable

• Vendor contract review
• Evaluate price strategies and contract terms with primary focus on pharmacy, therapy, laboratory, radiology, medical supplies/DME, respiratory, therapy and ambulance services
• Audits of vendor compliance with service timeliness, invoicing accuracy, and documented medical necessity to reduce risk of cost overruns in ancillary services
• Review cost containment strategies