Kelly Simonelli

Understanding Case Mix Index (CMI) and Why Accurate Documentation Matters

The Case Mix Index (CMI) is a numerical value assigned to each resident based on their acuity level.  Simply put, the higher the acuity, the higher the CMI value. Because CMI directly influences reimbursement, it is essential that it accurately reflects the clinical complexity of the residents being served. Under the Patient Driven Payment Model (PDPM), residents are classified into case mix categories based on several factors, including clinical characteristics, resident assessments, resident diagnosis and…

Understanding Chronic Care Management Compliance

Chronic Care Management (CCM) plays an important role in supporting patients with multiple chronic conditions by providing coordinated, ongoing care between visits. Since 2015, Medicare has recognized the value of this care by offering separate reimbursement for CCM services under the Physician Fee Schedule. However, with reimbursement opportunities also comes increased scrutiny. When documentation does not fully support the services provided, CCM programs can quickly become an audit target. Our latest whitepaper was developed to…

Sampling for Medical Chart Audits

In healthcare documentation audits, reviewing every single claim or record simply isn’t practical — yet reliable conclusions are still essential. That’s where audit sampling comes in. By thoughtfully selecting a subset of records to review, auditors can efficiently uncover insights and risks that reflect the broader population. Our whitepaper, Sampling for Medical Chart Audits, breaks down the most common sampling strategies and explains how choosing the right one impacts your results. What You’ll Learn From…