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| 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. |
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Nursing Systems Review
- MDS accuracy check to PDPM items
- 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
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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 on-site 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
On-site 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
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Therapy Program Review
- 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
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Billing Practices Review
- Billing office operations assessment
- UB04 accuracy audit
- Compliance with Medicare regulations
- ADR and denials management procedures
- Part B billing
- Accounts receivable and payable
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Ancillary Vendor Performance and Review
- 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
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