Capturing Accurate Reimbursement for Long-Term Care Series
member exclusive | 6-session series
Event Details
Webinar Schedule:
All sessions are 1:30pm-2:30pm CST/12:30 - 1:30pm MST
- July 9 – Understanding Reimbursement Systems in Skilled Nursing Facilities
- This session offers a foundational understanding of reimbursement systems in skilled nursing facilities, including Medicare Part A PDPM, Medicaid Case Mix, and Managed Care and alternate payment models. Participants will learn how reimbursement is calculated, and what operational strategies for accurate and timely reimbursement. The course also provides an in-depth look at the methodology and philosophy behind the Patient Driven Payment Model (PDPM), including variable per diem adjustments and case-mix adjusted components.
- July 16 – Documentation and Coding Accuracy
- The session will focus on the critical relationship between thorough clinical documentation and accurate Minimum Data Set (MDS) coding to ensure appropriate reimbursement. Participants will gain an understanding of how documentation supports MDS accuracy, common pitfalls that lead to revenue loss or compliance risk, and strategies to align interdisciplinary team efforts. Real-world examples and practical tips will be shared to improve coding precision, support regulatory compliance, and optimize facility reimbursement.
- July 23 – Medicare Advantage and Managed Care – Challenges, Compliance & Reimbursement Strategies
- This session explores the evolving landscape of Medicare Advantage and Managed Care in skilled nursing facilities. Participants will gain clarity on how these plans differ from Traditional Medicare, what challenges facilities commonly face, and how to develop proactive workflows to reduce denials and optimize reimbursement. Real-world case scenarios and strategies will be discussed to promote better outcomes and financial sustainability.
- July 30 – Optimizing Reimbursement in Skilled Nursing Facility
- Missed PDPM reimbursement opportunities can reduce revenue. To optimize reimbursement and avoid missed opportunities requires an astute understanding of the nuances of the payment model. The course will concentrate on the elements that influence optimal reimbursement. Participants will gain an understanding of the importance of flexibility with Medicare assessment scheduling and the importance gathering timely accurate assessment data for optimal reimbursement.
- August 6 – Quality Reporting Program Impact on Reimbursement
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The IMPACT ACT of 2014 requires the collection of standardized quality data across post-acute care settings, aiming to enhance the quality of care for Medicare beneficiaries through improved availability of consistent data. The course will provide an overview of the SNF QPR, and quality measures used in the program. Participants will gain an understanding of how SNFs collect and submit data to CMS, including the deadlines and submission requirements and monitor for compliance with these requirements
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- August 13 – Leveraging Technology and Data Analytics to Drive Quality Outcomes
- This session provides an overview of how long-term care facilities can harness technology and data analytics to improve clinical decision-making, monitor performance metrics, and enhance resident outcomes. The session will highlight practical tools, iQEIS Reports, and the importance of integrating data into daily quality improvement processes.
This 6-week intensive series is designed for healthcare professionals seeking to master the complexities of reimbursement in skilled nursing facilities (SNFs). Each session will provide in-depth insights into the strategies and best practices essential for capturing and optimizing reimbursement under Fee-for-Service, Value-Based Care, and the Patient-Driven Payment Model (PDPM).
Participants will explore critical topics such as accurate documentation and coding, effective MDS assessments, interdepartmental systems and the intricacies of managed care and Medicare Advantage plans. The series will also cover the impact of quality reporting on reimbursement, offering strategies to improve quality measures (QMs) and ensuring reimbursement accuracy for the care and services provided.
Presenters:
Sarah Becker RN, RAC-CT, DNS-CT, QCP, Clinical Consultant
Proactive LTC Consulting, LLC
Sarah is a results-driven healthcare leader with over 25 years of experience across acute and post-acute care settings. Currently serving as Director of Clinical Reimbursement at Proactive LTC Consulting, Sarah’s extensive background includes roles such as Vice President of Clinical Reimbursement, Director of Nursing, MDS Coordinator, and Healthcare Solution Consultant Engineer.
Christine Twombly, RN-BC, RAC-MT, RAC-MTA, HCRM, CHC,
Senior Clinical Consultant, Proactive LTC Consulting, LLC
Christine is a clinical consultant with Proactive LTC Consulting. Ms. Twombly is a certified gerontological nurse, a certified resident assessment coordinator (RAC-CT), a certified AANAC master teacher for both the RAC-CT and RAC-CTA certifications, a health care risk manager (LHRM), and is certified in healthcare compliance (CHC). Christine has more than 28 years of experience in post-acute care, including many years of hands-on experience with MDS assessments and related care planning. She has worked under Medicare PPS for skilled nursing facilities (SNFs) since its
inception and has a strong working knowledge of PDPM for Medicare, as well as, both RUGS and PDPM models for Medicaid CMI. Christine is an approved Master Trainer providing RAC-CT and RAC-CTA certification courses through AAPACN. She has extensive experience working with SNFs to conduct Medicare documentation and billing compliance assessments, assisting with driving facility specific Five Star Rating work plans, and providing assistance with third-party medical review and the
appeals process.
Eleisha Wilkes, RN, GERO-BC, RAC-CTA, RAC-CT, DNS-CT, Senior Clinical Consultant, Proactive LTC Consulting, LLC
Eleisha Wilkes is a Board Certified Gerontological Nurse and AAPACN certified MDS consultant with over twenty years of
experience in long term care.
She has served as a Director of Nursing, Case Manager and Resident Assessment Coordinator with extensive responsibility and success in driving QA in the areas of person-centered assessment and care planning through effective systems, staff development, and interdisciplinary team collaboration. Eleisha specializes in RAI completion, MDS validation audits, Medicare and Medicaid reimbursement compliance, competency-based staff education programs, and works with clients extensively to
facilitate SNF/NF survey readiness. She also contributes to McKnight’s LTC News as the “Ask the Payment Expert” columnist.