Protect revenue across Part A/Part B workflows, documentation scrutiny, payer audits, and aging A/R — with measurable SLAs and exception-based precision.
In long-term care, reimbursement isn't just about "billing correctly." It's about proving coverage, medical necessity, and documentation integrity across multiple payers, timelines, and audits, while teams are stretched thin and patient complexity rises. IntegraRCM stabilizes cash flow with structured workflows, exception handling, and cadence-based A/R management aligned to your facility's payer mix and system configuration.
We adapt workflows to your platform's claim formats, remittance routing, and reporting needs.
If you use a different platform, we map your current claim flow and reconcile file/ERA formats during onboarding.
Targets vary by payer mix, facility type, and system configuration. We baseline KPIs during onboarding and define SLAs to match your priorities.
Eligibility & Benefit Validation
Documentation & Coverage Readiness
Charge Capture & Claim Prep
ERA/EOB Intake & Posting
Denial Prevention & Appeals
KPI Reporting & Root-Cause Fixes
Clear coverage + clean documentation + fast posting + disciplined follow-up = predictable cash.
| Operational Area | Before IntegraRCM | After IntegraRCM |
|---|---|---|
| Eligibility-related denials | Coverage lapses found late; avoidable rework | Real-time validation + exception queue reduces preventable denials |
| Medical necessity / documentation denials | Notes incomplete; payer scrutiny triggers reversals | Documentation readiness checks + payer-specific fixes |
| Posting turnaround | Backlogs create A/R blind spots and delays | Faster posting + reconciliation reduces unapplied cash |
| A/R aging (90+ days) | Aged buckets drift; timely filing risk increases | Cadence-based touches + escalation prevents aging out |
| Predictability of cash | Reactive management; limited root-cause clarity | Dashboards + denial clustering drive systemic prevention |
Client: Multi-facility SNF organization with mixed Medicare Advantage and Medicaid volume
Challenge: Denial rates increased due to documentation gaps and eligibility volatility. Posting backlogs created A/R blind spots, and aged balances approached timely filing limits.
What we implemented:
Typical outcomes after stabilization:
Note: Results vary by payer mix, facility workflows, and system configuration. We define KPIs during onboarding and report against targets.
| Model | Description | Best For |
|---|---|---|
| Per-Claim / Per-Account | Fixed fee per claim batch or A/R account worked (with QA + reporting) | Single-facility SNFs, smaller post-acute groups |
| Dedicated Team Model | Dedicated team aligned to your systems, cadence, and denial/appeal workflows | Multi-facility organizations, high volume |
| Hybrid Model | Retainer + variable fee for overflow, aged-bucket recovery, and special projects | Facilities with seasonal spikes, audits, or staffing instability |
Each engagement begins with onboarding: baseline KPI audit (DAR, %AR>90, denial mix), workflow mapping, integration setup, and SLA definition.
Most organizations see early momentum in 30–60 days (posting + backlog reduction), with deeper denial prevention gains as systemic fixes mature.
Geriatrics and SNF revenue cycle management coordinates eligibility, documentation readiness, claim submission, posting accuracy, denials/appeals, and A/R follow-up across Part A, Part B, Medicare Advantage, and Medicaid, so balances stay collectible and cash remains predictable.
Common drivers include eligibility mismatches, documentation gaps that fail medical necessity standards, payer-specific edits, and delayed follow-up that pushes accounts into timely filing risk. Our workflow reduces these with validation checkpoints, documentation controls, and cadence-based A/R touches.
Yes. We commonly support PointClickCare, MatrixCare, Netsmart, and integrated environments (Epic/Cerner). During onboarding, we map your claim flow, remittance routing, and reporting to your platform configuration.
Most facilities see early momentum in 30–60 days through posting/backlog reduction and clearer A/R movement. Denial prevention and documentation integrity gains compound over time as systemic fixes are deployed.
We'll review a sample of claims and remittances, measure denial mix and posting turnaround, identify documentation/coverage leakage points, and provide a KPI baseline with recommendations (A/R cadence, denial clustering, and prevention fixes).
Assessment reports are typically delivered within 10 business days.