Reimbursement Consulting

Strategic, Clinically Driven Solutions to Optimize Your Reimbursement

In post-acute and senior care organizations, reimbursement isn't determined in the business office — it's driven by what happens at the bedside and in the medical record. Accurate assessments, thorough documentation and strong clinical workflows determine how much your organization is paid by Medicare, Medicaid, managed care and other payers.

Richter's reimbursement consultants work alongside your clinical teams to strengthen the processes that drive reimbursement: MDS accuracy, supporting documentation, quality measures and federal and state required assessments. The result is reimbursement that accurately reflects the care you deliver, fully supported, fully compliant and fully captured.

Reimbursement Challenges We Solve

• Ensuring MDS assessments are accurate, complete and submitted on time

• Aligning clinical documentation with assessment coding to fully support reimbursement

• Optimizing reimbursement under PDPM and state Medicaid case-mix systems

• Strengthening clinical workflows that impact revenue and quality outcomes

• Improving performance on quality measures that affect reimbursement and referrals

• Preparing for and responding to medical reviews and audits

• Educating and training clinical staff on the connection between care, documentation and reimbursement

How We Do It

Richter's reimbursement consultants assess your clinical processes, people and technology to identify where documentation gaps, assessment inaccuracies and workflow breakdowns are leaving earned revenue uncaptured — or exposing your organization to compliance risk. We then design and implement customized strategies, and we educate your clinical teams so improvements are sustained long after our engagement ends.

Reimbursement is a clinical function: your nursing, MDS and interdisciplinary teams drive it, while your financial teams track and report it. That's why our approach is rooted in clinical expertise and focused on the true revenue drivers of your organization.

Reimbursement Consulting Services for Post-Acute and Senior Care

MDS Process and Documentation Review

We conduct a comprehensive review of your MDS process, from assessment scheduling and completion through transmission, and evaluate whether supporting documentation substantiates your coding. We identify gaps, develop corrective strategies and train your team to sustain accuracy and compliance.

Clinical Workflow Assessment and Redesign

We evaluate the clinical workflows that feed your assessments and documentation, then redesign them to capture the full scope of care delivered — improving both reimbursement accuracy and resident outcomes.

Quality Measures and Outcomes Improvement

Quality measures influence revenue, star ratings and referral relationships. We help you understand your quality measure performance, identify root causes of underperformance and implement clinical strategies for improvement.

Federal and State Assessment Compliance

We help ensure all federal and state required assessments are completed accurately and on time, keeping your organization compliant and your reimbursement fully supported.

Clinical Staff Education and Training

We educate your nursing, MDS and interdisciplinary teams on how their daily work drives reimbursement — building organization-wide understanding, accountability and best practices.

Looking for support with billing, collections and accounts receivable? Visit our Revenue Cycle Consulting page.

Enhance Reimbursement Outcomes with Richter

To learn more about how Richter's reimbursement consulting can help your post-acute or senior care organization Enhance Outcomes in your organization, please fill out the form below to request more information or contact us here.