Beyond Keywords: AI for Reimbursement Accuracy in Long-Term Care
For years, many healthcare organizations have relied on keyword search tools to comb through clinical notes. On the surface, it seems logical: type in a diagnosis, find the word, and capture it for reimbursement. But real-world documentation isn’t that straightforward
From Manual Reimbursement Audits to Proactive, Continuous Intelligence
For decades, skilled nursing leaders operated in a reactive cycle. MDS teams submitted assessments, operators waited for the billing cycle to close, and only then could they see whether they had hit their reimbursement marks. By that point, it was
AI Proves to be a Safety Net in Skilled Nursing Reimbursement
In skilled nursing, the line between accurate reimbursement and lost revenue often comes down to the smallest details. A missed ADL, a subtle change in oxygen use, or an overlooked function score fluctuation can translate into thousands of dollars in
PDPM Medicaid Transition Playbook: 5 Best Practices for Long-Term Care Leaders
As several states prepare to transition Medicaid reimbursement toward a version of the Patient‑Driven Payment Model (PDPM), long‑term care executives must be strategic and proactive. Below, we outline the current landscape in numerous states making the switch to Medicaid PDPM,
Stay Ahead of Key Changes to the Function Quality Measures
In the skilled nursing industry, function quality measures play a vital role in quantifying facility performance. These measures provide valuable insights for consumers and providers alike into resident outcomes, helping facilities improve care and comply with regulatory requirements. Recently, the two
The Critical Role of Section GG in Nursing Home Medicaid Reimbursement
For skilled nursing facilities (SNFs), precise and comprehensive documentation isn't just a regulatory requirement—it’s a driver of financial stability. One essential piece of this puzzle is Section GG of the Minimum Data Set (MDS). This section directly influences reimbursement rates
Discharge Function Score – A Simple Guide
The Discharge Function Score will be used to assess the functional status of patients at discharge. It is a comparison measure that measures whether a resident’s observed discharge function score meets or exceeds an expected discharge function score. The Discharge
Harnessing AI to Enhance Reimbursement Efficiency
The skilled nursing industry is inherently complex and data-intensive, where accuracy and efficiency are paramount. One area that requires exceptional precision is clinical data capture for reimbursement — the process of gathering and documenting detailed information about a patient's medical
Resource Strains Threaten Reimbursement – AI Automation is a Solution
Turnover. Burnout. Staff shortages. Overtime. These are all consistent themes playing out in our nation’s nursing homes and splashed across the industry headlines each and every week. It’s not just impacting front-line staff either