Your Case Manager Advocates

• managed care MASTER is a purpose-built platform designed to simplify, track, and optimize managed care contracts for skilled nursing facilities and long-term care providers. 

• Unlike generic solutions, our platform is tailored for post-acute providers, featuring real-time reimbursement modeling, rate libraries, authorization workflows, and integration with claims and census systems.

• Yes. Our platform includes tools to manage pre-authorizations, track changes in payer policies, and ensure contract compliance.

For providers, managed care contract terms greatly affect key aspects of healthcare operations, including payment structures, daily practices, record-keeping, confidentiality, office organization, and clinical decision-making, all of which influence patient care quality.

• In the PDPM, there are 5 case-mix adjusted elements: Nursing, Occupational Therapy (OT), Physical Therapy (PT), Non-Therapy Ancillary (NTA), and Speech-Language Pathology (SLP). Each resident is to be categorized into one and only one group for each of the 5 case-mix adjusted elements.

• Under the Patient Driven Payment Model, there are a greater number of valid HIPPS codes compared to RUG-IV. Note that there are many fewer assessment signs under the PDPM. PDPM has 25 Nursing case-mix groups, 16 PT/OT case-mix groups, 6 NTA case-mix groups, and 12 SLP case-mix groups, which increases to 28,800 combinations.