PE-backed skilled-nursing operator
Our role
Strategy and engineering
The problem
Skilled-nursing reimbursement depends on the MDS assessment and the PDPM coding behind it. When documentation is thin or inconsistent, the facility finds out after submission. By then a fix means rework, resubmission, and money at risk.
Reviewers could only check a sample of records by hand, so most gaps surfaced late.
What we built
We built a system that reads each record before it is filed and flags missing or inconsistent documentation against MDS and PDPM requirements.
Each flag shows the passage that raised it. A reviewer on the operator's team makes every call.
The result
Reviewers catch problems while they are still cheap to correct. Coverage no longer depends on how many records a person can read in a day.
What they ownThe review system, its rules, and the documentation, running in the operator's own environment.