Clinical Navigator

5 High-Risk Clinical Targets for Skilled Nursing Facilities – 1 Solution

Skilled nursing facilities (SNFs) track dozens of clinical, financial standards and quality measures for internal benchmarking, as well as for reporting to and compliance with governmental agencies. Given the large volume of data generated by SNFs of all sizes, and the myriad ways such data could be used, we at Richter recently undertook a process to create performance initiatives that provide proactive mitigation of risks in five key areas:

1. Minimum data set (MDS) billing errors
2. Incident/Accident reports and outcomes
3. Quality Assessment Process Improvement (QAPI) programs
4. Quality measures and Five-Star rating
5. Case mix index (CMI) maximization

To help your organization mitigate risks in these important areas and enhance performance, we developed Clinical Navigator. Watch a video that explains more about Clinical Navigator and how it can help your organization reach new heights of performance and outcomes.

Challenges that Clinical Navigator Solves

• Targeting and mitigating five high-risk areas throughout your organization
• Optimizing performance and profitability in each target area; and ultimately
• Helping you enhance patient outcomes

How We Do It

Advanced SNF Compliance and Improvement in Five Target Areas │ Fully Customized for Your Facility’s Unique Needs

Clinical Navigator works to decrease MDS billing errors by:

• Identifying issues early on to decrease the likelihood of survey citations, complaint substantiation and post-payment recoupment
• Decreasing MDS errors to increase overall reimbursement
• Identifying coding issues to improve Five Star Rating and Quality Measures
• Decreasing billing-related errors to decrease the time it takes for the facility to receive payments

Clinical Navigator tracks and trends incident reports and outcomes by:

• Identifying incident trends to make recommendations on how best to improve
• Ensuring appropriate documentation to decrease the likelihood of survey citations and complaint substantiation

Clinical Navigator can assist you in your QAPI processes by:

• Identifying specific areas for Performance Improvement Projects (PIPs) to decrease the scope and severity of survey citations
• Identifying strategies to improve overall resident outcomes and the customer experience

• Increasing your Five Star Rating to assist you in being a preferred provider
• Reviewing your Quality Measures to identify high-risk areas and work with you on a proactive plan to mitigate risk
• Improving Quality Measures to improve facility processes and improve resident outcomes

Clinical Navigator can increase overall CMI by:

• Identifying opportunities to capture services to improve your overall CMI
• Completing a targeted review to identify missed opportunities for higher reimbursement
• Identifying employee concerns to improve employee engagement and increase retention which will increase the overall Five Star Rating

How It Works

Reporting

After the close of each month, you will receive a report detailing any identified risk and areas for improvement, as well as recommendations. Each report will include:

MDS billing

• Audit report for MDS compliance
• Recommendations for improvement (including in QAPI where necessary)

Incident reports and outcomes

• This includes pulling reports, categorizing reportables, trending issues, and reviewing documentation for follow through with interventions in care plans and overall documentation
• We provide recommendations for improvement and assist you with implementation of new tools and/or processes

QAPI

• We review policies, procedures and current PIPs
• We identify areas of improvement (informed by data points above)

Quality Measures and Five Star Rating

• We provide recommendations for improvement (included in QAPI where necessary)
• We provide a report for trends/tracking of Quality Measures to ensure appropriate reporting for your current population

CMI

• We report on current CMI to identify opportunities for coding improvements and service capture:
• ADLs, depression, restorative and overall rehabilitation
• We provide recommendations for improvement (include in QAPI where necessary)

Value Added Services

The following items are included in the Clinical Navigator monthly retainer:

• Monthly webinar on topical, timely content related to new regulations, survey preparedness, nursing documentation, etc.
• Additional reporting as necessary for process improvement and supportive services
• Quarterly newsletter containing regulatory updates, case studies and relevant content

Additional Services

Richter can customize your Clinical Navigator to meet your organization’s specific needs by including any or all of the following:

• Development of nursing policies and procedures
• Ongoing education and staff development
• Triple Check implementation and training
• Survey preparedness assessment
• Clinical process review
• Compliance audits
• Infection control – implement and train for ASP
• System/database configuration and utilization review
• EHR scorecard interpretation

Enhance Outcomes With Richter

To learn more about how Clinical Navigator can help you optimize your skilled nursing facility’s performance in the five high-risk target areas, please fill out the form below to request more information or contact us here.