Post-Acute Care Providers
Strengthen reimbursement integrity across post-acute care.
Reimbursement for post-acute care keeps changing quickly as CMS rolls out more value based care programs, has a greater focus on documentation, and has stepped up its monitoring of medical necessity and care quality. With specialized claims and coding audits, ZechionMed provides post-acute organizations with the tools to recognize revenue leakage, minimize compliance risk and maximize reimbursement accuracy.
Our post-acute audit experts know the distinctive business, clinical, and regulatory considerations that impact home-based care, hospice and skilled nursing reimbursement models in 2026.
What We Cover
Common Risks Identified
Improve Accuracy of Reimbursement for Home Based Care.
Audit Focus Areas
- OASIS documentation accuracy
- PDGM payment validation
- Eligibility for a skilled service reviewed by a skilled person.
- Homebound status verification
- Follow-up with a plan of care compliance
- Face-to-face encounter requirements
- Compliance with Certificate and re-Certificate.
- Visit utilization analysis
- Therapy service documentation
- Medical necessity validation
- Documentation consistency review
- The readiness of ADR and TPE.
Common Risks Identified
- Wrong clinical grouping codes
- Incomplete physician certifications
- Documentation to support for lack of skilled need
- OASIS assessment inconsistencies
- Incorrect timing adjustments under PDGM
- Missed reimbursement opportunities
What We Cover
Common Risks Identified
Minimize compliance issues and risks within end-of-life care billing.
Audit Focus Areas
- Hospice eligibility documentation
- Terminal prognosis validation
- Medical necessity review
- Level-of-care billing accuracy
- Normal billings for home care services
- Continuous home care billing.
- General inpatient care billing.
- Rebuilding your Respite Care Bill Review.
- Physician certification requirements
- Face-to-face encounter compliance
- Length-of-stay monitoring
- Documentation sufficiency analysis
Common Risks Identified
- Unsupported terminal diagnoses
- Missing physician certifications
- Incorrect level-of-care assignments
- Lack of documentation to support hospice eligibility.
- SESTAY compliance exposures.Exposures for extended stay compliance.
Ready to strengthen your revenue cycle?
Let our specialty billing team handle the codes, claims, and follow-ups — so your clinicians can focus on patients.
What We Cover
Common Risks Identified
The PDPM Reimbursement Models focus on protecting revenue.
Audit Focus Areas
- MDS assessment accuracy
- PDPM reimbursement validation
- Nursing component review
- Validation of non-therapy ancillary scores
- Therapy billing accuracy
- Each service area's ICD-10 diagnosis coding review.
- Failure to adhere to interrupted stay policy
- Review of the clinical categories assigned.
- Documentation integrity assessment
- Medical necessity validation
- Medicare coverage review
- Staffing Medicaid billing compliance training.Staffing Medicaid billing compliance training.
Common Risks Identified
- Incorrect MDS coding
- The clinical categories for unassigned PDPM cases.Clinical categories of unassigned PDPM cases.
- Therapy billing inconsistencies
- Missed reimbursement opportunities
- Inadequate documentation in RAC / UPIC audits
What We Cover
There are numerous advantages to outsourcing
Post-acute reimbursement requirements continue to grow increasingly complicated as CMS pursues additional program integrity and payment reform programs. Having internal expertise in a variety of reimbursement methods may be costly and time consuming.
There are numerous advantages to outsourcing
There are numerous advantages to outsourcing to ZechionMed.Outsourcing to ZechionMed offers several benefits.
- Access to certified post-acute reimbursement specialists.
- Knowledge and understanding of PDGM, PDPM, OASIS, and MDS rules and regulations, as well as hospice rules and regulations.
- Improved compliance and audit risk reduction
- Independent and unbiased review procedures
- Improved revenue leakage detection.
- Improved payer readiness
- Reduce the staffing and training requirements for internal personnel.
- Flexibility in support as the company grows or acquires.Flexibility of support for growth or acquisitions.
- Regularly updates on CMS rules.Ongoing updates on CMS rules.
- Medicare, Medicaid, Medicare Advantage and commercial payers are accepted.
Frequently Asked Questions
We support: Home Health Agencies Hospice Providers Skilled Nursing Facilities Long-Term Care Facilities Rehabilitation Facilities Continuing Care Retirement Communities Post-Acute Health Systems Multi-State Post-Acute Organizations
Contact ZechionMed
Talk to ZechionMed
Talk to ZechionMed about post-acute care providers.