Comprehensive Consulting Across Every Service Line

Skilled (Medicare-Certified)

• Medicare certification — CMS Conditions of Participation (CoP)
• PDGM (Patient-Driven Groupings Model) workflow implementation
• OASIS & Plan of Care (POC) setup and clinical documentation
• Clinical documentation systems and quality assurance
• Survey readiness preparation and mock surveys
• Accreditation — CHAP, ACHC, Joint Commission

Non-Skilled (Medicaid & Private Duty)

• Personal Care Services (PCS) / Homemaker/Personal Care (HPC) setup
• Medicaid provider enrollment and credentialing
• Caregiver workflows, documentation, and compliance systems
• Scheduling, EVV integration, and service tracking

Medicare — Nationwide (All 50 States)

• Provider enrollment — CMS Form 855A and PECOS setup, any state
• Billing setup — PDGM, claims processing (837/835)
• Survey preparation and mock survey readiness
• OASIS accuracy and clinical documentation review
• PDGM grouper accuracy and reimbursement optimization

Medicaid — State Program (Deep Specialty)

• Medicaid provider enrollment and credentialing
• Claims setup and billing configuration — state-specific
• Authorization and eligibility workflows
• Fee-for-service and managed care billing setup
• Plan of Correction (POC) development and submission

• State licensing application and facility approval — all states
• State Department of Aging, Developmental Disabilities, and Medicaid compliance requirements
• Facility planning, zoning guidance, and layout review
• ADA compliance review and inspection readiness
• Program development — social and medical day models
• Staffing ratios, qualifications, and training requirements

• Participant intake, assessment, and care planning
• Medicaid and waiver billing integration — state-specific programs
• Home and Community-Based Services (HCBS) waiver Adult Day enrollment
• Transportation coordination and compliance
• Activities programming and therapeutic service documentation

• DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics & Supplies) enrollment
• Medicare Part B supplier number enrollment and NSC accreditation
• Accreditation preparation — ACHC, CHAP, HQAA
• Supplier standards compliance — all CMS requirements
• Surety bond requirements and supplier standards
• Product line setup — wheelchairs, hospital beds, oxygen, CPAP, wound care

• HCPCS coding and claims billing setup
• Prior authorization and LCD/NCD coverage policy guidance
• Medicaid DME billing and prior authorization workflows
• Documentation compliance — CMNs, written orders, proof of delivery
• Audit defense — Medicare RAC, CERT, and MAC audit preparation
• Competitive Bidding Program (CBP) guidance

• Full gap analysis against accreditation standards
• Policy and procedure customization to meet all standards
• Clinical documentation setup and compliance review
• Mock surveys — full internal simulation with written findings
• Survey-day coaching and staff preparation

We Review

• Clinical documentation — OASIS, POC, visit notes, accuracy review
• Billing and claims accuracy — denial patterns, coding compliance
• EVV compliance — visit validation and documentation
• HR and personnel files — credentials, training records, supervisions
• Policies and procedures — CMS, state, and accreditation alignment
• Infection control, safety, and QAPI program review
• Survey readiness — full internal checklist

You Receive

• Detailed deficiency report with findings
• Compliance risk scoring by category
• Step-by-step correction plan and implementation timeline

• Emergency survey deficiency response and POC development
• Immediate corrective action planning and implementation
• Documentation failure correction and staff retraining
• Workflow redesign — clinical, billing, and operational
• CMS Informal Dispute Resolution (IDR) support
• Survey readiness preparation post-deficiency
• License reinstatement and re-enrollment consultation

• Medicare home health billing — full PDGM implementation
• Medicaid billing — fee-for-service and managed care
• DODD and waiver billing — complex multi-staff, overlapping shift billing
• EVV setup — Sandata integration and Alt EVV configuration
• Electronic claim submission (837) and remittance (835)

• Authorization tracking, validation, and management
• Denial management — root cause analysis and appeals
• Revenue cycle dashboards and KPI monitoring
• Payroll and timesheet system integration
• County-based rate structures and reimbursement optimization

• RN, LPN, and therapy staff onboarding systems
• Home Health Aide (HHA) training program setup
• Personal Care Aide (PCA) and DODD DSP training compliance
• Competency evaluations and skills assessments

• Mandatory compliance training — abuse, HIPAA, infection control
• Performance improvement and corrective action procedures
• Employee file and personnel record compliance review
• HR audit readiness and supervisor documentation

• Multi-location setup and expansion planning
• New service line additions — waiver programs, DME, ADC
• Workflow design and operational efficiency review
• KPI tracking and performance reporting systems
• Growth strategy and market analysis
• Agency resale preparation and valuation readiness