Medicare Consulting Services

A service designed to evaluate key systems throughout your organization that could impact Medicare compliance and related revenue. PolarisGroup Medicare consultants for providers will evaluate your systems related to Admissions, MDS, nursing, therapy, billing, and ancillary vendor contracts. Our Medicare consulting services will identify opportunities to improve revenue, decrease cost, and reduce compliance risk for denials, and we’ll even provide employee training and resource manuals.

Never in the history of SNF Reimbursement or Payment, has diagnosis coding affected, let alone, driven payment. Welcome to the world of PDPM! A missing or incorrect ICD-10 Code can impact your revenue under PDPM so it's important that your team knows how to identify accurate primary diagnoses. Polaris Group will provide an audit of current ICD-10 Coding practices and selection of Primary Reason for Admission as well as training to improve coding practices of your team. Audit will include ICD-10 coding including comorbidities, all of which impact Case Mix Group Assignment and PDPM payment. Training provided based on findings and ICD-10 best practices for PDPM.

Are you achieving accurate Case Mix Groups under PDPM for proper payment? We can provide your team with detailed feedback on coding accuracies as well as identify areas of risk for denials. Audit can include compliance with waiver rules as well as OBRA/Medicaid records to check for accuracy for PDPM data gathering. Our Medicare training and consulting focuses on allMDS PDPM related items including:

• Primary diagnosis entered into I0020B (primary reason for admission)
• SLP comorbidities/NTA comorbidities
• Documentation to support PDPM case mix groups

With PDPM, there are over 161items on the MDS which could impact payment. Now all the qualifiers for Nursing Component of the rate must be accurate, as well as comorbidities. Our audit and training will focus on the items below, to help you achieve greater MDS Accuracy for proper payment and reduce your risk for denials:
   

• All MDS PDPM related items including I0020B (primary reason for admission) that sets default clinical category under PDPM
• NTA/SLP Comorbidities

Polaris Group's 5-Claim Audit Services will help you navigate CMS’ latest Medicare audit, the 5-Claim Probe. Our experienced consultants are here to alleviate the stress of the 5-Claim Probe by providing personalized support every step of the way. We help you respond to the MAC’s audit requests, including reviewing your medical record and documentation, offering strategic guidance on additional documentation to include, and pinpointing any gaps or errors in advance. Our team of experts have successfully guided numerous facilities through audits and are well-versed in CMS compliance. Services include:

• Review the medical record and audit documentation to ensure records support MDS Assessment coding
• Review the record for supplemental documentation to support MDS Assessment coding
• Flag any coding issues to the facility
• Examine evidence to verify compliance with Medicare rules (e.g., physician certification)
• Ensure that the record is orderly and that the MAC can locate the information they need without difficulty