Bridging Payment Models and Value-Based Care: Optimizing Reimbursement with Data-Driven Strategies

Navigating the complexities of today’s healthcare payment models is yet another challenge faced by an already overwhelmed post-acute care industry. Whether the focus is Patient Driven Payment Model (PDPM), Managed Care, or Value-Based Care (VBC), one thing is certain – quality care delivery and effective clinical reimbursement are both essential for nursing facility success.

This session explores strategies nursing facility administrators, clinical teams, and leadership can implement to enhance the reimbursement process. The pivotal role MDS Coordinators play in Managed Care, Denials Management, and Additional Documentation Requests (ADRs) will be highlighted, as well how interdisciplinary collaboration – particularly between Medical Directors, MDS coordinators, and compliance teams – can improve documentation, optimize physician queries, and ultimately boost reimbursement outcomes.

Participants will learn the impact live data analytics can have on optimizing reimbursement outcomes, enhancing care coordination, reducing avoidable rehospitalizations, managing length-of-stay, and empowering MDS Coordinators to ensure all documentation is complete, supported, and compliant. The session will also emphasize the importance of checks and balances within the interdisciplinary team, outlining how each discipline can leverage live data to best collaborate and advocate for both patient care and the financial health of the facility.

Learning Objectives

• Compare the similarities and differences among various post-acute payment models and explain the importance of adopting a value-based care mindset
• Analyze the role of MDS Coordinators and interdisciplinary teams in improving clinical reimbursement
• Apply live data analytics to improve care coordination, reduce rehospitalizations, manage length-of-stay, and ensure compliant documentation in nursing facilities

Speaker

• Michele Self, MA-SLP, Customer Success Manager, Real Time Medical Systems

This live session will take place at the inaugural Health Care Council of Illinois (HCCI) Annual Convention.