Maximize Medicare Reimbursement
Medicare reimbursement is only as accurate as the clinical documentation behind it. AssistedCare ensures that every assessment, every therapy minute, and every diagnosis is captured correctly — so your claims reflect the true acuity of care you provide.
Challenges in Revenue Cycle
Undercoding Reduces Reimbursement Below Cost of Care
When clinical documentation does not capture the full complexity of a resident's condition, PDPM case-mix classifications drop. Your facility provides high-acuity care but gets reimbursed at lower-acuity rates.
Part A Denials for Insufficient Medical Necessity
Medicare Part A claims require clear documentation of skilled nursing necessity. Vague progress notes and incomplete assessments give payers grounds to deny coverage retroactively.
Benefit Period Transitions Create Coverage Gaps
Tracking benefit period days, skilled level of care requirements, and the transition between Part A and Part B coverage requires constant vigilance. Missed transitions mean unbillable days.
How AssistedCare Solves It
PDPM Case-Mix Optimization
The system maps clinical documentation to all five PDPM components — physical therapy, occupational therapy, speech-language pathology, nursing, and non-therapy ancillaries — in real time. Documentation gaps that reduce reimbursement are flagged immediately.
See PDPM Optimization→Medical Necessity Documentation Prompts
Guided documentation templates ensure that skilled nursing necessity is clearly established in every progress note and assessment. The system prompts clinicians for the specific language Medicare requires.
Benefit Period Tracking
Automatic tracking of benefit period days, skilled level of care certifications, and coverage transitions. The system alerts your team before benefit periods expire so there are no gaps in coverage or billing.
Pre-Submission Claim Validation
Every Medicare claim runs through comprehensive edit checks before submission. Common rejection reasons — missing modifiers, invalid diagnosis pairings, incorrect provider numbers — are caught and corrected before the claim leaves your facility.
See Billing Platform→Explore Related Solutions
Frequently Asked Questions
Yes. The system handles Part A skilled nursing facility consolidated billing, Part B ancillary services, and the billing transition between benefit periods. Claims are generated in the appropriate format for each coverage type.
Medicare Advantage plans have plan-specific authorization requirements and billing rules. The system tracks each plan's requirements, manages prior authorizations, and generates claims in the format each plan requires.
Yes. The system calculates projected PDPM reimbursement based on the current MDS assessment before it is finalized. MDS coordinators can see how documentation changes would affect case-mix classification and reimbursement.
Therapy minutes are documented at the point of care by therapists and flow directly into both the MDS assessment and billing records. The system tracks group versus individual therapy, concurrent therapy, and co-treatment rules automatically.
Most facilities are fully operational within two to four weeks. Our implementation team handles data migration, staff training, and workflow configuration. We work around your schedule so there is zero disruption to resident care.
Ready to See It in Action?
Try AssistedCare free and see how it transforms your facility operations.