PDPM Eligibility Verification Solution Sheet

June 3, 2019

Getting reimbursement right under PDPM begins with having your payer foundation set up properly. Your organization will have to support both Medicare and non-Medicare payers, and knowing which item set to use is critical. Without the right item sets and assessments to complete, you may end up in a default situation if incorrect choices are made.

How can you ensure payer information visibility? By putting in place the tools to guarantee access to the latest payer information and resident insurance coverages. Eligibility Verification delivers this essential visibility.

Eligibility Verification provides instant access to resident payer information directly from within the PointClickCare platform. Identifying which residents follow PDPM rules and those that do not becomes clear cut. With this information, you’ll then know which payer item set to use for the applicable assessments and the associated timing, minimizing any risk to your revenue flow that stems from managing multiple payers.

Providing payer visibility at assessment completion is only part of the revenue stream protection Eligibility Verification offers. Eligibility Verification also has real-time verification checks available throughout the resident’s stay as well as automated verification of all residents’ coverages on a weekly basis to make sure that your organization is never caught off guard by any uncommunicated changes in coverages that could potentially delay your reimbursement.

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