PDPM pays on documented clinical complexity, not therapy minutes — so one ICD-10 misassignment or an underreported MDS Section G score can quietly reset a resident’s per-diem rate across a 100-day stay. Healthcare Logic delivers skilled-nursing RCM that closes the gap between the care you deliver and the reimbursement you actually collect.
Skilled nursing reimbursement turns on documentation and classification accuracy that general hospital or physician billers simply do not carry. These are the gaps we close.
34 mapping revisions took effect October 1, 2025, reclassifying many diagnoses to Return-to-Provider status. A vague primary diagnosis now resets the whole payment category.
Under-scored ADL self-performance silently lowers the nursing case-mix component on every single claim — revenue that is gone before you ever see it.
Most ancillary services must roll onto one SNF claim. Outside providers billing Medicare directly for covered Part A services creates real recoupment exposure.
Authorization expirations on extended stays are a top denial driver, and Part A, Medicaid per-diem, and MA each run on a different clock that has to be watched.
A complete skilled-nursing RCM stack, run by coders trained specifically on post-acute rules.
Primary-diagnosis selection, ICD-10 specificity, and MDS assessment review aligned to current case-mix rules.
Correctly bundled SNF claims with monitoring for ancillary services that should never bill Medicare directly.
Part A day tracking across the 100-day benefit period so you never bill outside coverage windows.
Authorization windows tracked per resident and payer so renewals are requested before they lapse.
Aged AR over 90 days triaged by payer and root cause, with a defined rework and appeal cadence.
Documentation discipline and reporting built to withstand CMS data-validation audits and OIG scrutiny.
Confirm coverage, benefit-period days, and payer hierarchy before care is billed.
Validate primary diagnosis, ICD-10 specificity, and Section G scoring.
Build clean, correctly bundled claims and catch direct-bill exposure.
Submit and monitor each claim through payer adjudication.
Work denials, recover aged balances, and report results transparently.
The Patient-Driven Payment Model pays your facility based on each resident's documented clinical complexity rather than therapy minutes. Your per-diem rate is built from the primary ICD-10 diagnosis, MDS assessment data, and case-mix components. A single misassigned primary diagnosis or an under-scored ADL on MDS Section G can lower the rate on every claim across a stay, so coding precision is the difference between accurate payment and silent revenue leakage.
Yes. Under consolidated billing, most services a resident receives during a covered Part A stay must roll onto a single SNF claim, even when an outside provider delivered them. We assemble those claims correctly and flag when an ancillary vendor is billing Medicare directly, which is a common source of recoupment exposure during audits.
Yes. Aged AR recovery is a core part of our engagement. We triage your 90+ day balances by payer and root cause, rework the recoverable claims, and build a defined follow-up cadence so older balances stop sitting untouched until someone has time.
Medicare Advantage authorization expirations on extended stays are one of the leading SNF denial drivers, and MA, Medicaid per-diem, and Medicare Part A each run on different timelines. We track authorization windows per resident and per payer so renewals are requested before they lapse rather than after a denial lands.
Our delivery teams in India operate strictly as secure access points, not data locations. All protected health information stays on US-hosted infrastructure under role-based access controls. We are glad to walk your compliance team through the full security model before any engagement begins.
Let us run a no-obligation review of your PDPM coding, consolidated billing, and aged AR — and show you exactly where the revenue is leaking.
