Total quality management services to assist you in monitoring or improving your compliance with Federal, State and local regulations.

Compliance Billing Management

• Our management system provides your facility with many benefits:

• Strict compliance with Medicare Part A & B regulations Utilize CMS QIS Audit tool

• Denial Management Services

• RAC Audit preparation services
• Federal (DOJ, OIG or CMS audit preparation services)
• Denial/appeal services for all 4 levels: redetermination, reconsideration, administrative law judge, federal court review

• Functional reporting and G-Code compliance auditing and training

• UBO4 Review
• Documentation review for severity modifiers (comprehensive therapy, to be trained in other G-Code areas)
  
  

Regulatory Educational Services: Our corporate compliance department is comprised of physicians, nurses and therapists with numerous certifications that provide ongoing educational resources to your community.

• Credentials and certifications comprised of: RN, RNAC/MDS coordinator, RAC-CT, C-NE, CPHQ, PT, OTD, OTR, SLP-CCC, Infection Preventionist (IP), NHA
• Compliance Services:

• Customize and implementation of policies and procedures
• Restorative nursing audits or program implementation
• Creation and/or implementation of customer satisfaction surveys
• Program implementation and customization
• Documentation and Environmental auditing (monthly/quarterly)
• Total Quality Management (TQM)

• Compliance Communication-Compliance consultants are available to meet directly with administration, nursing and/or QAPI teams.
• Continual Quality Improvement-Through routine on-site visits compliance audits the delivery of therapy services and documentation.
• Full report with recommendations provided to administration upon completion of audit

Our management system provides your facility with many benefits:

• Compliance with Medicare Part A & B regulations Utilize CMS QIS Audit tool
• Denial Management Services
• RAC Audit preparation services
• Federal (DOJ, OIG or CMS) audit preparation services
• Denial/appeal services for all 4 levels: re-determination, reconsideration, administrative law judge, federal court review
• Functional reporting and G-Code compliance auditing and training
• UBO4, UBOR, and Remittance Advice Review

• Customize and implementation of policies and procedures
• Restorative nursing audits or program implementation
• Creation and/or implementation of customer satisfaction surveys
• Program implementation and customization
• Documentation and Environmental auditing (monthly/quarterly)
• Total Quality Management (TQM)
• Compliance Communication-Compliance consultants are available to meet directly with administration, nursing and/or QAPI teams.
• Continual Quality Improvement-Through routine on-site visits compliance audits the delivery of therapy services and documentation.
• Full report with recommendations provided to administration upon completion of audit

Our comprehensive restorative training and support includes: onsite training, a trainer’s manual, video modules for ongoing training after implementation, a Restorative Manual with Policies and Procedures and audits of the Restorative program before and after implementation.

• Provide treatment of restorative clinical modules
• Outline the philosophy and basic principles of restorative nursing
• Demonstrate accurate and complete documentation following best practices
• Provide knowledge in current regulations
• Define how to provide the necessary care for a restorative nursing resident including their physical, mental and psychosocial well-being
• Identify fundamental evidence-based nursing interventions that meet individual needs and promote positive resident outcomes
• Describe how the restorative nursing staff is an integral member of the healthcare team
• Recognize care giving challenges that restorative nursing team members may face when providing care to residents with a variety of conditions or chronic diseases

Do you need an experienced interim RNAC/MDS coordinator or DON to step into your team?

Gravity Healthcare Consulting offers interim daily, weekly and monthly relief coverage services to alleviate stress during your time of need. Our RNAC/MDS coordinator's have a minimum of 17 years’ experience and our certified DON has 22 years of Long Term Care experience. Our interim specialists are experienced and RAC-CT certified and will assist your facility is compliant with state and federal regulations per RAI Manual guidelines.  Our professionals are ready to start today!

Gravity Healthcare Consulting offers interim RNAC/MDS coordinator relief to alleviate stress during an interim time of need. Call us today! We can help during situations that arise in your community.

RNAC Short-term PRN staffing relief

• Maternity leave
• Vacation coverage
• Flex-time
• PRN Contractor
• Sick Leave
• Other

Our RNAC/MDS coordinator's are experienced and RAC-CT certified and will assist your facility is compliant with state and federal regulations per RAI Manual guidelines.

Gravity Healthcare Consulting offers interim daily, weekly and monthly relief coverage services to alleviate stress during your time of need. Our experienced and exceptionally qualified NHAs are able to provide leadership and stability to your community.

Our Administrator Consultants have a history of excellent survey results and census development with strong financial management. Known as team builders with commitment to staff development and customer service,  our NHAs have excellent analytical and communication skills and are ready to start today!

Auditing and analyzing all aspects of CMI, ADL coding, missed opportunities, scheduling, rehab involvement and restorative nursing involvement.  Full report with recommendations provided to administration upon completion of assessment and substantiation of requirements as indicated by the needs of your organization.

Understanding ADL Coding for Optimal Reimbursement

• The 4 late loss ADLs and how they affect reimbursement
• The two types of ADL coding
• The difference between guided maneuvering and weight bearing assistance when coding Self Performance
• Definitions of Levels of Assist
• Understand how the ADL score is calculated
• Financial Impact to your facility

CMI Medicaid Reimbursement Training

• Educating your team on strategically setting MDS assessment dates for OBRA assessments to maximize reimbursement effectively and appropriately.
• Demonstrating how the interdisciplinary teams directly affect reimbursement (Therapy, Restorative, Nursing, Social Services, and Activities etc.).
• Establishing an effective CMI system

Auditing

• CMI
• ADL Coding & Calculation
• OBRA (Omnibus Budget Reconciliation Act of 1987) Scheduling to optimize revenue appropriately

Key points:

• Stop copycat ADL coding in your facility
• Capture reimbursement and get paid for what your staff is actually doing

Gravity Health Care Consulting provides services to help you maintain Medicare compliance to help you maintain the highest level of reimbursement.  We have developed a variety of resources to provide clients with Medicare support services.  Our qualified team of healthcare experts can assess your facility's specific Medicare needs.

Evaluation may include:

• Evaluation of prior year Medicare process
• Medicare average reimbursement
• RUG utilization management
• Medicare average length of stay
• Calculation of Medicare margin
• Overview of your Medicaid cost report
• Medicare and Medicaid adjustment reconciliation
• Direct access to Gravity support team
• Medicare Support Services- consultants will evaluate your systems to identify opportunities to appropriately increase revenue, decrease cost, and reduce compliance risk for denials. Systems evaluated:

• Nursing
• MDS
• Case management
• Therapy
• Billing
• Ancillary vendor contract

Medicare Certification Support – providing assistance in obtaining Medicare provider number, staff training and education throughout the certification process.

Medicare Part A & Part B Utilization Benchmarking

• Compare Medicare Utilization across your corporate facilities — and to corporate trends
• Determine your Medicare Length of Stay and how it compares to other SNFs
• Ascertain whether your RUG level distribution is appropriate
• Measure your ADL scores accurately

Due to the vast changes in Medicare regulatory practices nurses today need more than just clinical experience. They need a full comprehensive expertise in systems management, regulatory practices and financial reimbursement while maintaining patient centered care.

Nursing Consulting Services can help you achieve:

MDS auditing for optimal and accurate reimbursement

• Optimal reimbursement through nursing ADL coding
• Audit 6 month snap shot MDS’s; PPS, Med A, Med B
• All sections of the MDS will be audited for coding vs documentation.
• ARD Optimization- strategically setting ARD to capture maximum reimbursement. Evaluating current strategies for choosing ARD dates.
• Quality CAAs and care plans by care team
• MDS Consulting

Successful surveys

• Quality Assurance Performance Improvement (QAPI) consulting and Total Quality Management (TQM)

• Evaluate every department to determine if a qualified QAPI plan is in place

• Using the CMS-QIS audit tool with prioritized recommendations.
• Review previous yearly survey for comparison and recommendations
• Perform Mock Survey upon community request
  • Review current mock survey results from outside vendors vs. Gravity
• Clinical program implementation for survey compliance

Review for effective and efficient interdisciplinary communication delivery and documentation systems

• Review current lines of communication (EMR v. Paper documentation/communication)
• Recommendations provided
• Implementation and training

Operational Services include:

• Improved resident outcomes
• CQI program implementation and QI investigations
• Effective nursing leadership and performance outcomes management

• New DON training and support
• New MDS nurse training and support

• Develop specialty program; selection process and training
• Discharge planning
• Discharge checklist and tools

• Equipment recommendations
• Education and technical eligibility
• Pre admissions review and screening processes
• Streamlining pre-admission decision

Onsite evaluation, auditing of your current in-house therapy program or contract provider.

Assessment components include:

• Full assessment of your rehabilitation program

• Communication & Interviews

       - Identifying administration, therapist, MDS coordinators, billing and nursing communication channels

       - Observation of treatment

• Environment

       - Evaluation of the available rehabilitation space, layout, equipment, and supplies

• Documentation

       - Review of documentation policies and procedures

       - Access EMR and provide utilization recommendations

       - Quality assurance and Corporate Compliance review

       - Assessment of therapy documentation

• Staffing

       - Assessment of your staff's educational needs

       - Evaluate staffing retention rates

       - Review staffing ratios

• Finance

       - A complete financial review of the therapy program, its relationship to all payers, including Medicare,

         and the managed care cost structure

       - Financial analysis of current therapy operation including CMI, Med B and outpatient potential

       - Financial analysis of rehabilitation strategic initiatives

       - Comprehensive analysis of therapy contract if not in-house

• Nursing

       - Restorative Nursing Program integration with Rehabilitation Analysis

• Rehabilitation

       - Review of therapy documentation and system to prevent claim denials

       - Provide percentage or claim denials and process established

       - Audit therapy program to ensure compliance with current regulation and practice acts with ICD coding accuracy

       - Rehab Rug analysis

       - CMI auditing and analysis

• Full report with recommendations provided to administration upon completion of assessment and substantiation of requirements as indicated by the needs of your organization

Our management team including reimbursement consultants will help you maximize reimbursement within regulations guidelines. This is accomplished by conducting a thorough review including financial analysis, accuracy of billing, timeliness of reimbursement, financial operating procedures, cost and charge structures, and compliance. Following our assessment, we will outline our findings, make recommendations to improve reimbursement, and assist in implementing any recommendations per your request.

• Executive leadership
• Management by statistics
• Organization board utilization
• Team building

• Customized program design, training and implementation
• Implementation of Policies and Procedures
• Human Resources department & documentation auditing

Gravity Healthcare Consulting’s completion of a Mock Survey will empower your staff to approach the facility’s upcoming survey with confidence. We will help develop their healthcare IQ and professionalism through the identification of strengths and weaknesses of the processes in place at your facility.

Mock Surveys are beneficial for several reasons:

• A Mock Survey is an opportunity to audit the facility systems to identify potential survey-risk areas. This empowers the staff to address those areas, improving outcomes and their confidence when approached by surveyors.
• A Mock Survey provides staff education of survey regulations and how the regulations relate to a deficiency.

A Mock Survey also can reveal how staff will function under stressful circumstances.

Our corporate compliance department is comprised of physicians, nurses and therapists with numerous certifications that provide ongoing educational resources to your community.

• Credentials and certifications comprised of: RN, RNAC/MDS coordinator, RAC-CT, C-NE, CPHQ, PT, OTD, OTR, SLP-CCC, Infection Preventionist (IP), NHA, and CSRS

Critical Pathways are resources and training methods to help your healthcare team optimize their clinical approach with focus on communication, accountability, and person-centered care.  Also, they help to systematize your clinical approach with focus on person-centered care and position your team to reduce unnecessary variations and services.  Consistent utilization of Critical Pathways will increase interdisciplinary team communication, decrease unnecessary complications, improve continuity of care between post-acute providers, and provide high quality of services to every resident.

Gravity Healthcare Consulting’s Critical Pathways Program follows 7-day and 14-day models with focus on excellence in resident care and improving functional outcomes.

There are 12 critical pathways, which includes six that are 7-day pathways and six that are 14-day pathways.

Diagnoses with a 7-day and 14-day pathway are:

     - Coronary Artery Bypass Graft (CABG)

     -  Congestive Heart Failure (CHF)

     -  Myocardial Infarction (MI)

     - Total Knee Arthroplasty (TKA)

     - Total Hip Arthroplasty (THA)

     -  General Rehabilitation

Each diagnosis has a pathway for the Care Navigator, Admissions, Administrator, Nursing, Certified Nursing Assistant (CNA), Director of Rehab, Physical Therapist, Occupational Therapist, Speech-Language Pathologist, MDS Coordinator, Social Services, Dietary, and Activities Director.

Includes a Resident Pathway that welcomes the resident to your community.  The Resident Pathway is a general outline for what a resident and/or family or caregiver are to expect when a resident enters your community from Day 1 through discharge and post-discharge.

Includes a pre-admission process outlining pertinent information and communication needed for the coordination of the resident’s transition from acute care to post-acute care.

Includes a post-discharge process that involves multiple departments, who will contact each resident and/or family member to ensure post-acute services are being delivered according to the discharge plan with the goal of ensuring  the resident’s needs are continuing to be met and provide continued support throughout the 30 days post-discharge from skilled nursing.