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  • Medicare Compliance

    Medicare Compliance and PDPM

    Theracore has always strived to ensure that skilled nursing facilities engage in the responsible provision of therapy services that achieves optimal clinical outcomes, facility regulatory and Medicare compliance. While our focus has not changed, under the new Patient Driven Payment Model, we are aware that facilities that have a history of overutilization of contracted therapy services will be more closely scrutinized if their utilization decreases significantly under PDPM.

    As such, before transitioning a facility to In-House therapy; Theracore performs an intensive assessment of a facility’s historical therapy utilization and Medicare compliance. The data is used to design a strategic plan for ensuring more appropriate utilization of therapy services while decreasing the facility’s risk for Medicare audits and denials.

    Theracore consistently performs ongoing audits of therapy documentation to ensure that the services provided are skilled, reasonable and medically necessary. We also work with Nursing and the entire interdisciplinary team to ensure that the medical record supports the skilled stay of all admissions.

    Any areas of non-compliance are identified and action plans detailing recommendations deemed necessary to achieve compliance are designed and implemented. Additionally, Theracore provides a variety of services and trainings that are facility specific and aimed at correcting deficiencies. Repeated auditing of clinical documentation and facility processes to ensure that compliance is maintained may also be recommended.