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Avamere Family Of Companies

Significant reduction in RAC Audit Claims

After identifying the need to improve the assessment process and to gain a better understanding of resident acuity, the team turned to PointClickCare’s Nursing Advantage and Care Insights solutions.

Challenge


Thoroughness of Assessments

Solution


Implementation of Nursing Advantage and Care Insights

Outcome


Increase in Documentation Consistency and Reduction of RAC Audit Claims

Avamere Family Companies

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65 Facilities

19 States with Avamere Family Services

Enhancing the Life of Every Person We Serve

How PointClickCare Helped Us

Avamere Family Companies, a group of independent privately owned post-acute care organizations has always been dedicated to improving seniors’ health and well-being. For years, Avamere desired to enhance assessment documentation to demonstrate the thoroughness and completeness of resident care. They also wanted to gain a better understanding of which residents were most at risk.

Avamere needed a better way to guide the nurse to create a more complete note that supports resident care. Incomplete documentation led to denials and revenue recouped through audit.

After identifying the need to improve the assessment process and to gain a better understanding of resident acuity, the team turned to PointClickCare’s Nursing Advantage and Care Insights solutions.

“Nursing Advantage has saved me so much work. I’ve noticed the content in our notes has increased, as far as supporting the patient’s stay, and I just can’t say enough good things about it. It took away so many issues that we were having consistently for years and Nursing Advantage solved it for us” says April Alexis, CPMA (Certified Professional Medical Auditor), RAC/Denial Manager at Avamere. The changes at the facility and use of Nursing Advantage also resulted in:

  • Increased clinically relevant content in notes
  • Decreased time to fill out documentation from start to finish
  • Lower readmissions to hospital within a few months
  • Improved charts for audits/auditors
  • Eliminated denials regarding supporting documentation for SNF care

The improved charts for auditors were an unexpected benefit of using Nursing Advantage. “We don’t see that happening anymore, where we receive a gray area denial where they’re saying the chart didn’t meet skilled criteria. We had a lot of gray area denials over the last five years for that specific reason. And I haven’t seen a single one of those since implementing Nursing Advantage,” says Alexis. In fact, the auditor commented that “your charts look amazing. It’s like reading a book. It’s like I can go in, and I can start from the first page of the chart and I can follow the patient’s care through the whole stay. And I can get a visualization of how this patient was treated, what this patient was going through.”

Avamere also noted success using the Skilled Evaluation Smart Assessment when they were identified as one of two emergency health care centers for COVID-19 that operated from April through July 2020. “You can see the improvement also in the quality of their documentation over time and how well the nurses would complete each body system. And it improved the application of nursing intervention” says Paula Love, Director of Clinical Informatics.

As Avamere’s documentation improved, staff noticed that appeals and denials went down drastically. “Coding within the MDS of isolation and, shortness of breath while lying flat were two of our biggest issues, auditors were just hammering us repeatedly regarding these. I haven’t seen one chart have these issues since the introduction of Nursing Advantage, and that alone is my success story” says Alexis. In the end, Avamere estimates that they saved millions of dollars from being reclaimed by auditors.

With Nursing Advantage, they now have enhanced documentation to support the coding of isolation and shortness of breath while flat that previously created a number of issues resulting in denials. “We were talking millions of dollars that were being audited because we didn’t have the documentation to support the skilled need, the coding of isolation, or the shortness of breath while lying flat on the MDS. So yes, the Nursing Advantage note does guide the reader to specifically talk about isolation, whereas before, the nurse just had to remember off the top of their head. What I like about Nursing Advantage is it guides the author to make a better note. So, if the nurse gets pulled away, they can come back and pick up right where they left off.”

Now that assessment information was being collected consistently from resident to resident, Avamere started to use Care Insights to analyze the data collected with Nursing Advantage. With all of the essential resident information in one place, they were able to use Care Insights to quickly and objectively identify who their sickest and highest risk residents were, taking the guess work out of prioritizing care. Love recounted this example: “As we were rolling this out in training, I was at the facility and showing them how Care Insights ranks patients by acuity. And as we were doing that the person at the top of the list was being sent out to the hospital. From that moment, they were believers.”

If you’re interested in improved completeness of documentation and thoroughness of assessment, while achieving the same success as Avamere Family of Companies, contact our team to discuss a specific solution customized for your needs.

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