Pursue Health runs monthly triple check in minutes! The digital audit trail and sophisticated rules are a breath of compliance fresh air.
Pursue Health runs its monthly TripleCheck in minutes with Acuri.
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.
Senior clinical and billing time reclaimed across 12 facilities.
The value of that reclaimed time.
The monthly TripleCheck per facility, down from six to eight hours.
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 does that check continuously, against every claim, before it is submitted, on the same 60+ Medicare compliance rules 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.
See what Acuri looks like in your facilities.
A fifteen-minute walkthrough on real claims from your portfolio.
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.