Pursue Health

Pursue Health runs 12 skilled nursing facilities. Before Acuri, the monthly TripleCheck was the most expensive meeting on their calendar: six to eight hours per building with the MDS coordinator, the billing manager, the DON, and a reimbursement lead in a room, reconciling every Medicare claim against the record by hand. Now Acuri checks the claims before the meeting, and the meeting is a short pass over the exceptions.

Pursue rolled Acuri out one building at a time. Before each facility started, we ran the rules against its recent claims and tuned them with the clinical operations and AR leads, so the checks matched how Pursue documents rather than a generic default.

The senior staff who used to reconcile line by line now look at the exceptions Acuri flags and sign off. The clinical and billing hours that went to checking data go back to patient care, to working AR, and to the claims that actually need a person, roughly 380 hours of senior staff time a month across the 12 buildings, worth about $300,000 a year.

When Acuri catches something, it catches it while the claim is still open, so Pursue fixes it the same day instead of finding it after the money is gone. Pursue is putting the rest of its facilities on Acuri, and has introduced it to other operators in its network.

The reason the check cost that much time is that most of it never needed a person. The senior staff sat with the UB-04s, the MDS assessments, the therapy logs, the physician certs, and the ancillary records, and reconciled every claim line against the documentation behind it, and most of it was always going to pass. The claims that actually drive denials and clawbacks do not show up until after submission, once the window has closed and the documentation is harder to recover, and the clawback lands months later, after the cash is spent.

Acuri runs 60+ Medicare compliance checks before submission to surface documentation gaps and give the team evidence to review.