Proactive offers proven clinical quality, reimbursement, and medical review consulting solutions.
Post-Acute Care Excellence
Proactive is an independent consulting firm specializing in post-acute care clinical excellence, regulatory and reimbursement compliance. Through our team of MDS certified nurses, therapists, and health facility administrators, we assist clients in achieving goals in the areas of 5 star survey, QAPI, compliance, audit readiness, and appropriate reimbursement.
Amie Martin and Shelly Maffia have been exceptional partners to work with on the QAPI in Action webinar series. They have provided needed information during each webinar for our membership, and the attendance for each webinar has exceeded expectations. Their professionalism and expertise is much appreciated as our members focus on building successful QAPI programs in critical performance areas. Click here to read more testimonials.
Proactive provides expertise in Survey Management including:
- Mock survey
- Survey support
- Plan of correction development and implementation
Phase 1, 2, and 3 Requirements of Participation (RoP) Implementation
Proactive has Partnership Plans to guide your facility through the New Requirements of Participation. We drive compliance alongside your team through a targeted work plan and tools to fill gaps in compliance including policy templates, facility assessment tools,, training resources, and program implementation. Contact us for information on our budget friendly consulting options.
RoP Consulting Our facilities were very pleased with the partnership with Proactive to help us tackle the enormous task of creating a facility assessment related to the RoP for phase one and two. Proactive was able to drill down to our facilities’ characteristics, needs and capabilities to create a facility specific plan. Each of the requirements was covered in an organized format and they walked us through each of the steps. We were never left alone during any phase of the data collection or compilation of the data, preventing our team from getting overwhelmed with the process. The staff at Proactive was extremely accessible to our team, allowing us to contact them with questions or concerns at any time via phone or email. The process could not have been easier and without the guidance of Proactive, our staff would have been taxed with pulling everything together with a lot of uncertainty. There was a vast supply of templates, resources and materials available to help us achieve compliance with the new regulations without requiring us to spin our wheels and waste time creating forms and documents to track all the required information. Proactive has created user friendly forms that helped to easily present the data and information in a format that surveyors will really appreciate and understand! The fee arrangements and installment plans were easy for us to follow and the cost was easily able to be managed into our budget to give us piece of mind and assurance that we are on the right track with such a huge endeavor. We are grateful for all their assistance!
Shop: F-tag Review Series on demand webinars
Shop: Facility Assessment Tool
Shop: March 2017 webinar 5 Star-Health Inspections
Shop: 5 Star on demand webinar series
Shop: Competency Toolkits and Policy Template
Blog: The New Survey Process Is Here—What You Need to Know
Blog: Your Staff Prepared for the New Survey?
Blog: Facility Assessment
Blog: Emergency Prep
Blog: Prepare your staff for survey
Blog: Digging in to survey
Blog: New Survey Process
Blog: F-tag review series
Blog: Requirements of Participation
Blog: Navigate the New Requirements of Participation (RoP) Phase 3 with Ease!
Find solutions and partnerships to drive SNF Quality Measures, Survey Outcomes and appropriate staffing levels. Achieve 5-Star results through a facility specific work plan and on-site performance improvement help from a dedicated expert.
Proactive understands the challenges of achieving and maintaining 5-Star Quality Measures. Our clinical consultants work alongside your team to drive coding accuracy, systems improvements, and staff engagement. We provide the boots on the ground assistance, real time support, and practical resources to propel QM outcomes.
Blog: 5 Star Work Plans
Blog: CMS 5 Star Quality
Blog: PBJ Reporting
Shop: March 2017 5 Star-Health Inspections On Demand Webinars
Shop: April 2017 5 Star-Staffing On Demand Webinars
Shop: May-Aug 2017 5 Star-On Demand QM Webinars
Blog: New Survey Process
Blog: Transitioning to PBJ Staffing Measures
Resource: Five-Star User’s Guide April 2019
Quality Assurance Performance Improvement (QAPI) Consulting
- Drive continual quality and care excellence by engaging Proactive’s QAPI certified practitioners to assist in enhancing programs and team skills to bring QAPI to life in your facility.
- QAPI plan development to meet Phase 2 Requirements of Participation (RoP)
- QAPI program policies, procedures and implementation assistance to meet Phase 3 RoP and drive 5 Star results
Identify improvement opportunities and achieve tangible outcomes through Proactive QAPI consulting, education & resources. Our team provides the systems analysis and clinical expertise to drive real results.
I felt compelled to contact you to express my heartfelt thanks for the wonderful (QAPI) training you provided… Your lecture along with the resources you made available are the best tools I have ever been given. Your mentoring will go a long way in my attempt to conduct a quality QA/QAPI program.
Consultants certified in health care compliance assist providers with QAPI and compliance program development, risk-based work plan implementation, program oversight and potential violation investigations. Interim Compliance Officer and Independent Review Organization (IRO) services available.
Ethics & Compliance Program Services
- Compliance Program Development
- Compliance Training
- Hotline Monitoring & Investigations
- Interim Compliance Officer Services
Compliance Programs and Compliance Officer Support
Proactive’s Certified Compliance Experts can meet your needs for the development and ongoing implementation of a SNF Compliance and Ethics Program
Did you know?
The average healthcare Compliance Officer (CO) salary is $99,659.00? Proactive offers individual facility Compliance Program implementation and oversight solutions for a fraction of the cost of employing a full time CO.
Blog: SNF Compliance & Ethics Program
Blog: Navigate the New Requirements of Participation (RoP) with Ease!
Shop: Dec 2017 Abuse Webinar on demand
3-Prong Approach to Reducing Denials
With therapist, billing, nursing and MDS specialists, Proactive is uniquely positioned to manage SNF claims reviews and investigations. Experienced help through ZPIC/UPIC, RAC, SMRC, MAC, CERT and insurance audits.
- Training and Audits – In-depth training followed by clinical documentation auditing
- ADR Management – Solutions for improved ADR payment outcomes
- Appeals – Complete appeals management and recoupment guidance
Additional Documentation/Development Request (ADR) Consulting
Proactive assists with implementation of effective medical review response systems to promote compliance and reduce errors resulting from government and other payer audits. Our ADR preparation services involve a thorough review of each claim by a clinical expert and an organized record is provided in a timely manner to the review entity. A clinical defensive position statement is drafted to clarify and highlight key information in support of the claim.
Proactive Consultants develop a customized clinical appeal which focuses on payer policy, clinical standards and evidence based practice. The consultant represents the facility at each stage of the appeal process, up to and including the ALJ hearing.
Proactive partner clients currently maintain an exceptionally low payment error rate of 5% under medical review at the ADR level after using our comprehensive program of training, clinical program tools, ongoing audits, and medical review response services. Proactive has historically overturned 93% of denied claims on appeal.
Proactive has had significant success in reducing overpayment liability for providers involved in ZPIC, UPIC and RAC reviews.
Medical Review can be overwhelming. Proactive can help. Our proven system yields improved payment outcomes under Medical Review.
Contact Proactive for assistance with Reimbursement Compliance, PDPM coding audits, PDPM documentation and coding support services, CMI accuracy, and Medical Review (ADR/Appeals) assistance.
SNF Risk Assessment
PDPM Support Services
Proactive’s MDS coding and documentation experts provide the coaching and validation services you need to succeed under PDPM. Let us assist you in coding accurately to capture the patient-centered care you’re providing to ensure proper Medicare reimbursement. PDPM Support Services include remote MDS validation audits, supportive documentation and coding training, and PDPM operational process improvement consulting. Facility specific projects and annual partner work plans are available. Proactive consultants are knowledgeable in the critical elements of MDS coding, SNF ICD.10-CM, systems of IDT clinical collaboration and reimbursement/billing compliance to assist your facility in developing PDPM expertise.
Blog: SNF PEPPER
Blog: Med B caps repealed
Blog: How will you fare under PDPM
Blog: Final Rule PDPM
Blog: PDPM Transitions
Blog: PDPM: Effective Systems and Coding of Section GG Recording Now Available!
Shop: PEPPER webinar
Shop: PDPM On-Demand Webinars
Shop: Restorative Nursing Competency Tool-Kit
Shop: PDPM Transition Action Plan Template
Proactive’s AANAC certified MDS experts offer the support your team needs to achieve your clinical assessment, coding and reimbursement goals. Contact us to ensure consistently accurate MDS coding, quality measures, and clean claims.
MDS Systems Audits
- RUGs IV to PDPM Transition Consulting
- MDS Data Integrity Audits
- MDS Training and Education
- MDS Systems Development and Management
- Medicare Program Compliance Audits
- Medicare Eligibility Reviews
- MCR and MDS Supportive Documentation Reviews
- Case Mix Reviews
- Mock Surveys
- ADL Coding Training and Auditing
- Medical Review Response
- Orientation of New MDS Staff
- Short-term Interim MDS Staffing
RAI Training and Education
- ADL Coding Training
- Orientation of New MDS Staff
- Medicare and MDS Supportive Documentation Training
- Person-Centered Care Planning
- ICD-10 Coding
- Restorative Nursing Programs
Documentation, Coding & Billing Validation and Quality Enhancement
- Targeted Medical Record Auditing & Monitoring
- MDS Coding Accuracy
- Reimbursement Compliance
- Physician Certification
- Contract or in-house therapy support and chart audit services
SNF Rehabilitation Stay Quality Assurance
Proactive offers medical record documentation reviews with emphasis on overpayment risk and current industry audit activities. An objective 14-point scale audit with individual clinician feedback highlighting examples of compliance in supporting care and coding, opportunities for improvement, and feedback on the active treatment course progression.
Rehabilitation Support & Oversight
- Therapy support and management services for in-house programs
- Rehabilitation auditing specializing in Medicare A, B and Insurance reviews for SNF Providers, TCU/Swing Bed Units, and Outpatient Therapy Clinics
- Rehabilitation Clinical Programs
- Coding & Documentation Training
- IRO/Skilled Service Oversight & Monitoring
F-tag 726 states that nursing facilities must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. Proactive’s Competency Tool-Kits help providers achieve Competency Based Training effectively and efficiently. Learn more about Tool-Kits here.
Medicare PDPM Transition Consulting
Proactive assists providers to succeed under evolving payment models including the Patient Driven Payment Model. Click here to learn more.
Education and Training
Proactive’s education offerings emphasize core training and clinical practice standards for optimal care quality, ethical practice, effective case management, and evidence based programs.
Let us put our experience in driving quality to work for you!
Contact us today to learn more about our services which are reasonably priced by the hour, project, or as part of an annual partnership plan.
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Q: What is the #1 ICD.10 coding error that you find in your audits? A: Answer: The coding error seen most often is using acute conditions/diagnoses. The RAI Manual states while certain conditions represent acute diagnoses, SNFs should not use acute diagnosis...
Q: Should presumptive positive COVID-19 test results be coded as confirmed? A: Yes, Presumptive positive COVID-19 test results should be coded as confirmed. A presumptive positive test result means an individual has tested positive for the virus at a local or...
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