From day one, I could tell this was a game-changer. Acuri revolutionized our TripleCheck process by automating the third check which is more thorough than the manual process. Gone are the days of manually validating a long list of compliance standards one at a time for each claim and documenting results on printed paper pre-bill forms. With Acuri, our teams feel more confident that they are billing clean claims.
How Aspen Healthcare took its monthly TripleCheck from a full day to under an hour with Acuri.
One of the facilities at Aspen Healthcare was the first building in the group to put Acuri in front of its billing. Before, the monthly TripleCheck took the MDS coordinator, the biller, the DON, and a reimbursement lead the better part of a day, going down every Medicare claim against the record by hand. Now Acuri checks the claims before anyone sits down, and the meeting is under an hour.
The monthly TripleCheck, down from a full day.
Senior clinical and billing time reclaimed at the facility.
Medicare compliance checks Acuri runs on every claim.
The facility was the first in the group to run its billing through Acuri. We started by testing the rules against its recent claims and sitting down with the clinical and AR leads, so the checks reflected how the building actually documents instead of a generic default.
The review that used to take a full day now runs in minutes. The team looks at the exceptions Acuri flags and signs off, and the clinical and billing hours that used to go to checking data by hand go back to patient care, to working denials, and to the claims that actually need a person.
When something is wrong, it shows up while the claim is still open and there is time to fix it, so nobody waits for the month-end meeting to find out. On the strength of that first building, Aspen Healthcare is extending Acuri to its other facilities.
That day was the most expensive meeting the building ran, and most of it was going to pass anyway. Its senior clinical and billing people spent the cycle reconciling every claim against the MDS, the therapy logs, the physician certs, and the rest of the record, while the claims that actually cause denials and clawbacks stayed hidden until after submission, once the billing window had closed and the documentation was harder to pull back together, and the clawback landed months later, after the cash was already spent.
Acuri does that check continuously, against every claim, before it is submitted. It runs 60+ Medicare compliance rules on each one, the checks that drive denials and clawbacks in SNF billing:
3-day qualifying stay: the inpatient hospital stay of at least three midnights is confirmed, not observation.
Primary diagnosis match: the primary diagnosis on the UB-04 matches the MDS and the PCC medical diagnosis.
HIPPS and ARD match: the HIPPS code and assessment reference date on the UB-04 match the MDS.
NTA points supported: every NTA point billed is backed by a documented diagnosis or physician order.
Section GG charting: GG is charted daily for the first three days after admission.
Certs and recerts: physician certifications and recertifications are present, signed, and dated.
Medicare Secondary Payer: the MSP form is complete and the CWF shows no open MSP issue.
NOMNC: the Notice of Medicare Non-Coverage (CMS-10123) is delivered, signed, and timely.
SNFABN: the SNF Advance Beneficiary Notice (CMS-10055) is complete, signed, and timely.
MDS transmitted and accepted: the MDS is transmitted to CMS and accepted, not still in progress.
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Book a demoAcuri is a Medicare billing compliance platform for skilled nursing operators. It runs 60+ Medicare compliance rules against every claim before submission and catches the documentation gaps that drive denials and clawbacks.