Strengthening Your First Line of Defense: Leadership Strategies for Claims Review in Today’s Audit Environment
Insights from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, IPCO, QCP, ICC – Director of Reimbursement and Education, Pathway Health In today’s regulatory environment, nursing home leaders cannot afford to take a passive approach to claims review. CMS has intensified external audit activity—from Targeted Probe and Educate (TPE) reviews to RAC audits—and organizations are seeing significant...
MDS Leadership in 2026: Accuracy, Audit Readiness, and Revenue Opportunity
Insights from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, IPCO, QCP, ICC – Director of Reimbursement and Education, Pathway Health As CMS increases oversight across skilled nursing, leadership teams must recognize that MDS accuracy is no longer just a clinical documentation issue—it’s a financial and compliance strategy. With improper Medicare payments tied largely to documentation gaps...
Section GG: Where Clinical Accuracy Meets Financial Performance
Insights from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, IPCO, QCP, ICC – Director of Reimbursement and Education, Pathway Health As skilled leaders recognize, the Minimum Data Set (MDS) is foundational to reimbursement accuracy—and Section GG sits at the center of that process. Section GG captures a resident’s functional performance at admission and discharge and directly...
Trusted MDS Consultants. Proven Reimbursement Protection.
Pathway Health’s MDS Consultants bring an average of more than 18 years of experience—seasoned experts, not entry-level staff or generalists. Each consultant is highly trained through advanced education and certification, with deep expertise in MDS, PDPM, and clinical reimbursement strategy. Our consultants are backed by national oversight from a clinically focused, nationally recognized Director of Clinical Reimbursement, ensuring...
Trusted MDS Consultants. Proven Reimbursement Protection.
Pathway Health’s MDS Consultants bring an average of more than 18 years of experience—seasoned experts, not entry-level staff or generalists. Each consultant is highly trained through advanced education and certification, with deep expertise in MDS, PDPM, and clinical reimbursement strategy. Our consultants are backed by national oversight from a clinically focused, nationally recognized Director of Clinical Reimbursement, ensuring...
New PATHTalks on ARD: A Leadership Imperative for Accurate Reimbursement and Compliance
Selecting the Assessment Reference Date (ARD) for the Medicare 5-Day and Interim Payment Assessment (IPA) is one of the most consequential decisions in the MDS process. Yet, it is often treated as a routine task rather than a strategic one. In today’s complex reimbursement environment, ARD selection directly influences payment accuracy, compliance integrity, and an...
Assessment Accuracy Is Strategy: Why MDS Excellence Defines Nursing Home Success in 2026
Insights from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, IPCO, QCP, ICC – Director of Reimbursement and Education Nursing home leaders are operating in an environment defined by complexity, transparency, and accountability. Regulatory expectations continue to evolve, reimbursement models grow more sophisticated, and public reporting increasingly shapes reputation and market position. In this reality, Minimum Data Set...
Managing Quality Measures Through the MDS Process
Insights from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, IPCO, QCP, ICC – Director of Reimbursement and Education Selecting the Assessment Reference Date (ARD) for the Medicare 5-Day and Interim Payment AssessmentQuality Measures (QMs) are central to how organizations are evaluated, reimbursed, and perceived by regulators, payers, and consumers. While many leaders associate QMs primarily with the...
ARD: A Leadership Imperative for Accurate Reimbursement and Compliance
Selecting the Assessment Reference Date (ARD) for the Medicare 5-Day and Interim Payment Assessment (IPA) is one of the most consequential decisions in the MDS process. Yet, it is often treated as a routine task rather than a strategic one. In today’s complex reimbursement environment, ARD selection directly influences payment accuracy, compliance integrity, and an...
Strengthen Your Case Mix Outcomes & Improve MDS Accuracy with Pathway Health
Nursing home providers are facing an increasingly complex environment – shifting payment systems, tighter reimbursement, and heightened scrutiny. Accurate documentation is essential to protect Case Mix reimbursement, reduce discrepancies, and prevent revenue loss. New Consulting Service: Case Mix Snapshot Review and SupportHaving a clear and accurate understanding of your facility’s Medicaid Case Mix performance is...
