Compliance Audits That Empower Your Team

Improve MDS accuracy to protect reimbursement and reduce the risk of recoupment and penalties.

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Strategic Reimbursement Consulting for Long-Term Care Facilities

Renshaw Reimbursement and Consulting delivers specialized consulting for long-term care and skilled nursing facilities, focused on improving reimbursement accuracy, strengthening documentation, and ensuring compliance with complex regulatory requirements.

MDS Auditing & Care Plan Review

Accurate MDS completion is critical to achieving proper reimbursement and maintaining regulatory compliance in long-term care.

Renshaw Reimbursement & Consulting delivers detailed MDS audits that evaluate completed assessments alongside supporting clinical documentation. We ensure coding accuracy, validate documentation, and confirm the resident’s condition and level of care are fully captured.

By strengthening documentation practices and internal review processes, facilities can confidently capture the full reimbursement they have earned-while reducing compliance risk.

During MDS audits, RRC helps facilities identify:

MDS signature, date, and interview timing discrepancies

Incomplete or inaccurate MDS coding

Missed clinical indicators affecting case mix

Inconsistencies and gaps in care plan development

Areas of potential regulatory risk

PDPM consulting services may include:

Review of PDPM classifications and case mix grouping

Primary diagnosis selection and clinical category review

Clinical documentation validation / identification of missed reimbursement opportunities

Recommendations to strengthen interdisciplinary documentation for audit defense

Section GG and functional scoring accuracy validation

PDPM & Reimbursement Optimization

The patient driven payment model (PDPM) has transformed how skilled nursing facilities are reimbursed under Medicare. Accurate clinical documentation and precise coding are essential to capturing appropriate payment.

Renshaw Reimbursement and Consulting partners with facilities to review PDPM classifications, validate supporting documentation, and ensure alignment with Medicare requirements.

By strengthening the connection between documentation, coding, and case mix classification, RRC helps facilities maximize reimbursement, reduce missed revenue opportunities, and maintain full regulatory compliance.

Medicaid Case Mix Index Review

Medicaid reimbursement is directly driven by accurate case mix classification. When resident acuity is not fully captured, facilities risk lost revenue and compliance exposure.

Renshaw Reimbursement and Consulting analyzes CMI data alongside supporting clinical documentation to support and validate resident classifications and ensure accuracy.

With accurate documentation and aligning it with case mix requirements, facilities can capture appropriate reimbursement, reduce mixed opportunities, and maintain compliance with regulatory standards.

Case mix consulting services may include:

Validate diagnoses against RAI criteria & supporting documentation

Identification of missed case mix and reimbursement opportunities

ARD timing for capture

ADL scoring & section GG documentation corroboration

Detect patterns leading to default CMIs & audit risk

The following processes may be audited:

PPS & OBRA scheduling compliance

Casper report resident level QM data

Quality Reporting Program (QRP) threshold percentages

Casper report facility level QM data

MDS completeness validation

Compliance & Quality Assurance Audits

Regulatory compliance is essential to protecting both reimbursement and operational stability in long-term care. Proactive auditing helps identify documentation and reporting risks before they become survey findings, financial recoupments, or fraudulent claims.

Renshaw Reimbursement and Consulting delivers these audits that provide an added layer of oversight across clinical, coding, and reporting processes.

By strengthening internal controls and validating documentation practices, facilities can reduce regulatory risk, prevent revenue loss, and maintain ongoing compliance with federal and state requirements.

Documentation & Coding Support

Accurate clinical documentation and diagnosis coding are essential to achieving proper reimbursement. When documentation does not fully support coding decisions, facilities risk lost revenue and increased scrutiny during audits.

Renshaw Reimbursement and Consulting works with facility teams to strengthen documentation and coding practices, ensuring alignment with current regulatory and reimbursement requirements.

By improving documentation integrity and coding accuracy, facilities can support defensible reimbursement, reduce audit risk and recoupments, and maintain compliance with health care regulations.

Support services may include:

ICD-10 diagnosis coding review

Clinical documentation improvement recommendations

Identification of unsupported or conflicting documentation

Interdisciplinary documentation alignment

Guidance on anticipatory documentation for future coding needs

Educational consulting may include guidance for:

MDS coordinators

Nursing leadership teams

Frontline nursing staff & point of care documentation

Reimbursement checks and balances

IDT members

Education & Consulting for Facility Teams

In addition to performing audits and documentation reviews, Renshaw Reimbursement & Consulting provides education and consulting support designed to strengthen facility teams and internal processes.

Our approach equips staff with the knowledge, tools, and systems needed to maintain accurate documentation and support consistent reimbursement outcomes.

By building strong processes and improving team alignment, facilities can sustain documentation accuracy, protect reimbursement, and maintain compliance long after the engagement ends.

Partner With a Revenue Integrity Specialist

Renshaw Reimbursement and Consulting partners with long term care and skilled nursing facilities to strengthen documentation, improve reimbursement accuracy, and maintain regulatory compliance while reducing the risk of recoupments and penalties.

From targeted audits to ongoing consulting support, we help facilities capture what they have earned - currently, defensibly, and with confidence.

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Our Reimbursement Guidance

We help long-term care teams tighten documentation, protect compliance and capture accurate reimbursement. Talk with our specialists to get started today.

Start a Facility Review