Medicare Consulting

PDPM is the biggest change the SNF industry has faced in over two decades. For the first time, diagnosis coding affects SNF payment. Our Medicare & PDPM Compliance Consulting brings Medicare and MDS expertise to your Medicare process.
Allow our expertise in Medicare and PDPM assist you in navigating this complex system with the tools necessary to not only achieve success but also maintain compliance and thrive in this post-pandemic world.

Service Offerings

Medicare Compliance and Operations Assessment (MCOA)

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

ICD-10 Training and Audits (On or Offsite)

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.

PDPM Training and Audits (Onsite or Offsite)

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. Training and Audit focus on all MDS PDPM related items including:

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

MDS Audits and Training (Onsite or Offsite)

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

Ready to determine if your PDPM payments are accurate?

Let our experts assist you with accurate payment and compliance.

  • Periodic Medicare audits and training can identify opportunities to improve revenue, decrease cost, and reduce compliance risk for denials.
  • Understanding of ICD-10 coding will ensure proper default clinical category under PDPM.
  • Accurate MDS coding for PDPM items will ensure all components are properly achieved including comorbidities for SLP and NTA.
Many Nursing Facility Operators have found our Medicare and PDPM Consulting Services to be a valuable asset in their navigation of the complex PDPM world by ensuring both compliance and proper PDPM payment.
Many Nursing Facility Operators have found our Medicare and PDPM Consulting Services to be a valuable asset in their navigation of the complex PDPM world by ensuring both compliance and proper PDPM payment.
Choosing the correct primary reason for admission diagnosis is crucial in achieving the correct CMI for proper PDPM payment.
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Contact Us

For questions or additional information, call us at 800-275-6252 or use the provided email submission form.

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