44-facility SNF operator

A large operator runs Medicare Part A billing across 44 skilled nursing facilities. Every month, before claims went to Medicare, each building ran its own TripleCheck by hand: billers and MDS nurses in a room reading diagnosis codes off paper and spelling out patient names while everyone else checked their own screens, about eight hours a building. Now Acuri runs that check on its own, and the month-end meeting is an hour or less.

Done by hand, the TripleCheck took about eight hours a month and pulled senior clinical and billing staff away from their other work. The harder problem was showing that the review was consistent. CMS projected $5.9 billion in improper payments for SNF services in its 2024 reporting period. With 44 buildings each running the check their own way, small inconsistencies added up, and leadership had no single view of whether the right checks were happening everywhere. Because the review happened at month-end, problems showed up in the meeting itself, which held clean claims and the cash behind them until the end of the cycle.

Acuri sits between the EHR and billing as an independent check. Claim data comes straight from PointClickCare, and Acuri checks every Medicare claim before it goes out: the documentation, the coding, and compliance across Part A, Part B, managed care, and HMO. It compares the MDS coding against the clinical documentation and catches the discrepancies in diagnoses, NTA qualifiers, and therapy classifications, and it flags missing signatures and gaps as they come up. The team no longer goes claim by claim. They look at the claims Acuri flags, the ones that actually need a person, and because the check runs continuously instead of once a month, problems show up when they happen instead of at month-end.

The monthly review dropped from about eight hours to an hour or less, and in a clean month, close to nothing. The billers and MDS nurses get that day back. Leadership can see compliance across all 44 buildings in one place and confirm the same checks are running the same way everywhere. The cash moves earlier too: instead of finding problems at month-end, the operator catches and fixes them as claims are prepared, so clean claims go to billing earlier in the cycle.

Source: CMS: 2024 Medicare Fee-for-Service Supplemental Improper Payment Data