Reimbursement

Financial Stability from Quality Outcomes

Reimbursement

As a leader, you must support all efforts to capture data from positive quality outcomes to ensure your facility is properly paid, or reimbursed, for the valuable care and services you are providing. Optimization of reimbursement, and matching resource utilization to resident acuity, is an important part of improving financial performance for any health care organization.

To better prepare for the new direction of health care, including value-based purchasing, providers are looking to Pathway Health for assistance with tools, resources, and training. Assisting providers in their ability to achieve financial stability and quality performance in the complex reimbursement environment is our passion.

Unique Approach, Tailored to Meet Operational Goals

Pathway Health has specifically designed targeted clinical reimbursement and revenue cycle management resources and training. We start by analyzing your facility’s data to set benchmarks and expectations for performance improvement. We observe and interact with staff to assess their knowledge and competencies, as well as review internal processes to make adjustments that align with industry best practices.

Reimbursement and Revenue Optimization Services

  • Customized Reimbursement Assessment
  • RUG / Medicaid Case Mix / PEPPER Analysis and Performance Improvement
  • MDS / RAI / ADL Process Improvement
  • Medicare Compliance and Process Improvement
  • PPS Scheduling and ARD Process Review
  • Billing and Revenue Cycle Improvement
  • RAC/ZPIC Vulnerability Assessment

Data and Quality Analysis

  • PEPPER, CASPER and ASPEN Operation Analysis
  • SNF Performance Measure Operational Readiness Assessment
  • Quality Measures and Five-Star Performance Review
  •  Denied Claims Assistance

Reimbursement Training and Education

  • MDS Basics
  • Medicare
  • AANAC Certification and Recertification
  • Coding and Scheduling
  • Billing and Revenue Cycle
  • Certified INTERACT Champion 4.0 (CIC) Program
  • Customized Training for Facility Leaders, Clinicians, MDS Team and Billing Staff
  • E-learning Courses and Webinars

Restorative Program

  • Program Design and Implementation
  • ADL Tracking, Improvement and Training

National Initiatives

  • Care Transitions (ACO, Safe Transfer, Advanced Care Planning)
  • Hospital Readmission Reduction Program (HRRP)
  • Bundled Payments for Care Improvement (BPCI)
  • Medicare Advantage
  • Medicaid reform and case management

Pathway Health assists agencies across the nation to ensure they meet compliance and operational goals. Our hands-on approach continues with mentoring, training and education by our team members. Whether onsite or offsite, our reimbursement experts develop action plans to get you on the right path for achieving Medicare and Medicaid reimbursement positive outcomes.

 

Follow the right path to better reimbursement. Call 877.777.5463 to speak with our consultants.