Clinical Navigator

Long-term care rules and regulations have been changing at a fast and furious pace over the past few years. Often, changes can happen so quickly that it can be nearly impossible to train staff and update processes in time to stay current. We have seen this burden play out across all senior living facilities (SNFs), from independent homes to small and large chains alike.

With our unmatched experience and ability to assist SNFs, we at Richter decided to put our heads together and create the Clinical Navigator program(previously Virtual Corporate Nurse). Clinical Navigator is designed to target high-risk areas in the SNF setting and provide proactive mitigation of those risks. In addition, it offers reporting, value-added services, and much more. Clinical Navigator can be however involved you need it to be—it is fully customizable to your facility’s needs.

Read on for details about each aspect of Clinical Navigator and why they matter to your facility.

Five Target Areas

Clinical Navigator focuses on improvement in MDS billing, incident reports and trends, QAPI, Quality Measures and Five Star, and Case Mix Index (CMI):

  1. Clinical Navigator works to decrease MDS billing errors by:
    • Identifying issues early on to decrease the likelihood of survey citations, complaint substantiation and post-payment recoupment
    • Decreasing MDS errors to increase overall reimbursement
    • Identifying coding issues to improve Five Star Rating and Quality Measures
    • Decreasing billing-related errors to decrease the time it takes for the facility to receive payments
  2. Clinical Navigator tracks and trends incident reports and outcomes by:
    • Identifying incident trends to make recommendations on how best to improve
    • Ensuring appropriate documentation to decrease the likelihood of survey citations and complaint substantiation
  3. Clinical Navigator can assist you in your QAPI processes by:
    • Identifying specific areas for Performance Improvement Projects (PIPs) to decrease the scope and severity of survey citations
    • Identifying strategies to improve overall resident outcomes and the customer experience
  4. Clinical Navigator tracks and trends Quality Measures and Five Star Rating by:
    • Increasing your Five Star Rating to assist you in being a preferred provider
    • Reviewing your Quality Measures to identify high-risk areas and work with you on a proactive plan to mitigate risk
    • Improving Quality Measures to improve facility processes and improve resident outcomes
  5. Clinical Navigator can increase overall CMI by:
    • Identifying opportunities to capture services to improve your overall CMI
    • Completing a targeted review to identify missed opportunities for higher reimbursement
    • Identifying employee concerns to improve employee engagement and increase retention which will increase the overall Five Star Rating

Reporting

After the close of each month, you will receive a report detailing any identified risk and areas for improvement, as well as recommendations. Each report will include:

  1. MDS billing
    • Audit report for MDS compliance
    • Recommendations for improvement (including in QAPI where necessary)
  2. Incident reports and outcomes
    • This includes pulling reports, categorizing reportables, trending issues, and reviewing documentation for follow through with interventions in care plans and overall documentation
    • We provide recommendations for improvement and assist you with implementation of new tools and/or processes
  3. QAPI
    • We review policies, procedures and current PIPs
    • We identify areas of improvement (informed by data points above)
  4. Quality Measures and Five Star Rating
    • We provide recommendations for improvement (included in QAPI where necessary)
    • We provide a report for trends/tracking of Quality Measures to ensure appropriate reporting for your current population
  5. CMI
    • We report on current CMI to identify opportunities for coding improvements and service capture:
    • ADLs, depression, restorative and overall rehabilitation
    • We provide recommendations for improvement (include in QAPI where necessary)

Value Added Services: The following items are included in the Clinical Navigator monthly retainer:

  • Monthly webinar on topical, timely content related to new regulations, survey preparedness, nursing documentation, etc.
  • Additional reporting as necessary for process improvement and supportive services
  • Quarterly newsletter containing regulatory updates, case studies and relevant content

Additional Services: We can customize your Clinical Navigator to meet your organization’s specific needs by including any or all of the following:

  • Development of nursing policies and procedures
  • Ongoing education and staff development
  • Triple Check implementation and training
  • Survey preparedness assessment
  • Clinical process review
  • Compliance audits
  • Infection control – implement and train for ASP
  • System/database configuration and utilization review
  • EHR scorecard interpretation

As you can see, Clinical Navigator can be the extra set of hands your facility needs to allow staff to focus on what is most important: the care of your residents. Interested in learning more? Contact Senior Clinical Consultant Jennifer Leatherbarrow, RN BSN, RAC-CT, QCP, CIC, today by filling out the form below.

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