Maximizing Clinical Reimbursement: Strategies for Success

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. Margaret Kirby, Vice President of Clinical Reimbursement for National Healthcare Associates (NHA,) will share insights from her journey in increasing annual revenue by $3M/year for NHA’s 42 centers in six states. Margaret will discuss the pivotal role regional support teams and MDS Coordinators play in Managed Care, Denials Management, and Additional Documentation Requests (ADRs), as well as highlight how interdisciplinary collaboration–particularly between Medical Directors, MDS coordinators, and compliance teams–can improve documentation, optimize physician queries, and ultimately boost reimbursement outcomes.

Joining Margaret is Michele Self, Clinical Account Specialist at Real Time Medical Systems to discuss the impact live data analytics can have on optimizing reimbursement outcomes. Together, they will demonstrate how live clinical data can be utilized to enhance care coordination, reduce avoidable rehospitalizations, manage length-of-stay, and empower 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 regional support teams, 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

 Speakers: 

• Margaret Kirby, RN, GERO-BC, RAC-CT, RAC-CTA, DNS-CT, QCP, DCP, Vice President of Clinical Reimbursement, National Healthcare Associates
• Michele Self, MA, CCC, SLP, CMAC, Clinical Account Specialist, Real Time Medical Systems

This session will be presented live at the AHCA/NCAL Convention & Expo, Delivering Solutions ’25.