“CORE” Redefines Skilled Nursing Facility Claims-Based Intelligence
Morganville, New Jersey – October 3, 2018 - SNF reimbursement is rapidly transitioning from a fee-for-service system to a value-based, managed model that presents significant financial risk to providers. This “race to the top” requires data-driven outcomes to quantify a provider’s value-proposition in the healthcare continuum.
CORE (“Claim Outcomes & Reimbursement Essentials”) applies proprietary intelligence to current SNF-specific and accretive peer-group data to produce meaningful & actionable insights. The CORE UB-04 intelligence solution generates comparative analysis, risk management support and reimbursement optimization logic – specifically designed for SNF financial and reimbursement professionals.
CORE was developed by Zimmet Healthcare Services Group, LLC (ZHSG), a leading post-acute care consulting firm servicing 2,500+ providers and industry stakeholders nationwide. ZHSG launched CORE as a distinct company in October 2018.
“Today’s SNF performance analytics either rely on dated MDS-driven elements that offer limited financial insight, or historic public claims that lack important variable-sensitivity. We got tired of explaining to our clients that the reporting they purchased had little practical relevance,” explained Marc Zimmet, President and Chief Executive Officer of ZHSG and CORE. He added, “SNF stakeholders need one standard tool that measures outcomes, episodic spend and variable care-cost related to current activity – the UB-04 is the only source with the detail and consistency needed for comparative integrity. Add the complexity of Medicare’s new Patient-Driven Payment Model and this level of sensitivity is an imperative.”
When aggregated across the continuum of care, CORE’s advanced reporting generates critical insight into provider efficiency, quality and cost – precisely the information that our upstream providers and payers use to measure post-acute network performance.
“The Medicare claim offers key performance indicators that the MDS cannot measure, notably ancillary costs (e.g. therapy, pharmacy, diagnostics), physician efficiency and preceding inpatient utilization – including length of the qualifying hospital stay,” explained Vincent Fedele, Chief Operating Officer of CORE. These variables are essential to comparative and predictive insight at the patient/disease/comorbidity-specific level.
Also embedded within the CORE database are comprehensive hospital metrics formatted to highlight post-acute referral patterns and the quality / efficiency of local competitors – providing the CORE user a significant advantage in the escalating battle for short-term SNF admissions.
CORE requires absolutely no integration with a SNF’s EMR or billing software; instead using Medicare’s standard electronic submission 837i protocols. “Our goal was to make the onboarding process as simple as possible” Fedele stated. “Integration / implementation costs and contract term commitments are nonexistent. A new client can be up and running within 15 minutes, with more precise data to improve a provider’s position in the context of healthcare reform.”