How Windsor House Improved SNF Reimbursement Accuracy Without Adding Work for MDS Teams
For skilled nursing operators, reimbursement management has become one of the most complex and high-risk parts of the business. Medicare rules continue to evolve, Medicaid Case Mix Index plays a larger role in financial performance, Medicare Advantage plans apply inconsistent standards, and Quality Incentive Program requirements leave little room for error. Yet MDS teams are expected to manage all of it without additional time or resources.
Windsor House Inc., an operator of 11 skilled nursing communities, was facing this same reality. Their challenge was not staffing or effort. It was the growing gap between reimbursement complexity and the visibility needed to manage it effectively across a multi-facility portfolio.
When Manual Chart Review Limits SNF Reimbursement Performance
Like many skilled nursing organizations, Windsor House relied on manual chart reviews and facility specific workflows to manage Medicare, Medicaid, and Medicare Advantage reimbursement. Corporate and regional MDS leaders were spending two to three hours every day reviewing documentation. Even with that level of effort, it was difficult to consistently identify missed Medicare opportunities, ensure Medicaid CMI accuracy across all buildings, or spot QIP performance risk early enough to intervene.
This challenge became more urgent as changes to Ohio’s Medicaid payment model increased the financial impact of accurate CMI capture. Documentation gaps that might have been manageable in the past now created meaningful revenue risk across multiple communities. At the same time, Medicare Advantage plans such as Humana and Aetna applied different expectations around level of care, creating uncertainty during audits and payer discussions.
The issue was not diligence. It was a lack of real-time, portfolio wide insight into SNF reimbursement risk and opportunity.
Aligning Documentation, Reimbursement, and QIP Without More Work
Windsor House leadership was intentional about their goals. They were not looking to change clinical practice or increase manual workload for MDS teams. Instead, they wanted stronger alignment between documentation, reimbursement accuracy, and quality outcomes.
Their priorities included improving Medicare reimbursement capture, stabilizing Medicaid Case Mix Index performance across all 11 skilled nursing communities, and supporting Medicare Advantage level of care decisions with defensible data. Just as important was gaining earlier visibility into QIP performance so teams could address issues before thresholds were missed.
What they needed was a way to manage SNF reimbursement proactively rather than reacting after billing cycles had already closed.
How MedaSync Improved Visibility Across 11 Skilled Nursing Communities
To address these challenges, Windsor House implemented MedaSync to bring structure and consistency to reimbursement oversight across the portfolio. Instead of relying on time intensive chart reviews, MedaSync automated the identification of Medicare and IPA opportunities and used AI driven insights to highlight documentation and condition changes impacting Medicaid CMI.
This shift gave leadership a clearer view of reimbursement and quality risk across all facilities. Medicare Advantage level of care alignment became easier to validate, and QIP performance could be monitored early enough to make adjustments when it still mattered.
As Michael Betteridge, Corporate MDS, explained, “MedaSync helped us see opportunities we were missing without adding more work to our day. We’re more confident in our coding and we’re spending far less time digging through charts.”
Measurable Results in SNF Reimbursement and Operational Efficiency
The impact was both immediate and measurable. Daily chart review time dropped from two to three hours to approximately 15 minutes, allowing MDS leaders to focus on action rather than manual review.
From a financial standpoint, Windsor House improved performance across every major payer type. Medicaid Case Mix Index increased, enabling all 11 communities to meet their CMI goals. Medicare opportunity and IPA capture improved, generating approximately $1,500 per month per building. Medicare Advantage level of care capture also improved, giving leadership stronger data to support contract negotiations and payer conversations with Humana and Aetna.
Quality outcomes improved as well. Earlier insight into QIP performance allowed teams to course correct in time, helping every community achieve targeted QIP levels rather than reacting after the fact.
As Lanette Middleton, Corporate MDS, summarized, “What MedaSync gives me is peace of mind. I know the critical reimbursement opportunities are being surfaced, not missed, and I don’t have to worry that something important is slipping through the cracks.”
What This Means for Skilled Nursing Operators
Windsor House’s experience reflects a broader reality across the skilled nursing industry. Manual processes do not scale as reimbursement requirements grow more complex. At some point, even the most dedicated teams need better tools to protect revenue, quality performance, and compliance.
By moving from reactive chart review to proactive, portfolio wide reimbursement insight, Windsor House strengthened SNF reimbursement accuracy, reduced operational burden, and entered 2025 with greater confidence across Medicaid, Medicare Advantage, and QIP.
The full case study includes detailed insights into how MedaSync supported Medicaid CMI improvement, Medicare opportunity capture, Medicare Advantage alignment, and QIP performance across 11 skilled nursing communities.
Download the Windsor House case study to see exactly how they did it and what it could mean for your organization.