PDPM Audit Software That Reviews the Chart Before the Auditor Does
RevOptix1 gives skilled nursing facilities a second set of eyes on the chart.
The platform reviews available SNF documentation across the MDS, diagnoses, nursing records, therapy documentation and reimbursement-related data to identify documentation gaps, inconsistencies, supported opportunities and areas that may deserve additional review before an outside auditor sees the record.
Review the documentation. Find the gaps. Strengthen the chart.
PDPM Is More Than a HIPPS Code
Under the Patient-Driven Payment Model, Medicare Part A SNF payment is based on resident characteristics and classification across multiple components rather than the volume of therapy delivered.
CMS uses clinical information, diagnoses, functional information and other resident characteristics in determining PDPM classification.
That makes documentation integrity critical.
A facility may have the correct information somewhere in the chart while still having inconsistencies between:
- physician documentation
- nursing documentation
- MDS assessment information
- ICD-10-CM diagnoses
- Section GG
- therapy records
- NTA conditions
- PDPM classification
- claim information
RevOptix1 helps bring those pieces together for review.
What RevOptix1 Reviews
Depending on the information included in the chart export, RevOptix1 can assist your team in reviewing:
ICD-10-CM and Primary Diagnosis
Identify diagnoses and documentation that may warrant review against the diagnosis reflected in the record and the applicable PDPM clinical category.
MDS-to-Chart Alignment
Compare available MDS information with supporting clinical documentation to identify inconsistencies or areas requiring additional review.
Section GG
Review functional documentation relevant to Section GG and identify potentially conflicting information across the interdisciplinary record.
NTA Documentation
Locate information potentially relevant to Non-Therapy Ancillary classification and identify where supporting documentation deserves closer review.
Nursing and Clinical Documentation
Review clinical documentation for inconsistencies, missing support and information that may not be carried consistently through the record.
Therapy Documentation
Compare available therapy documentation with other portions of the clinical record when relevant to the review.
HIPPS and Claim Information
When claim information is supplied, review relationships between available clinical evidence, assessment information and reimbursement-related data.
Find Both Missed Opportunity and Audit Risk
A meaningful PDPM audit should not simply look for ways to increase reimbursement.
It should look in both directions.
Documentation-Supported Opportunities
RevOptix1 may identify areas where the available clinical record contains information that deserves additional review for potential MDS, diagnosis or reimbursement implications.
Documentation Risk
RevOptix1 may also identify information already reflected in the assessment or reimbursement record that appears inconsistent with, or insufficiently supported by, the documentation supplied for review.
That distinction matters.
The goal is not to maximize every possible code.
The goal is to help the facility identify a result that is supported by the resident record.
Why Review the Chart Before an Auditor Does?
CMS and its contractors can review SNF documentation to determine whether Medicare coverage, coding and medical-necessity requirements are supported.
CMS has specifically identified SNF PDPM documentation and medical necessity as an area subject to complex medical review.
A documentation problem that is obvious during an internal review is much easier to address before a request for records arrives.
RevOptix1 helps facilities identify potential issues earlier.
How RevOptix1 Works
-
Upload the Chart
Use a supported clinical export from your existing EHR. RevOptix1 is designed to work with common SNF export formats rather than requiring your facility to replace its current clinical system.
-
RevOptix1 Reviews the Available Record
The platform analyzes the supplied documentation and identifies relationships, inconsistencies and items that deserve further review.
-
Review the Findings
Your team sees the supporting information associated with each finding so qualified facility personnel can determine whether action is appropriate.
-
Correct the Process, Not Just the Chart
Individual findings can also reveal recurring documentation, workflow or training issues. Those patterns can help administrators, MDS teams and clinical leadership identify where process improvement may be needed.
Built for Skilled Nursing Teams
RevOptix1 can support:
- Administrators
- MDS Coordinators
- Directors of Nursing
- Reimbursement Teams
- Compliance Officers
- Regional Clinical Leaders
- Multi-Facility Operators
- Revenue Integrity Teams
Instead of asking staff to manually review every page of every chart, RevOptix1 helps identify where human attention may be most valuable.
Keep Your Existing EHR
RevOptix1 is an additional chart-intelligence layer.
It is not intended to replace your EHR.
Depending on the system and export available, RevOptix1 can work with common clinical data formats including:
- CCD
- HL7
- FHIR
- other supported chart exports
Software Identifies. Your Team Decides.
RevOptix1 is decision-support technology.
It does not automatically change the MDS, alter a diagnosis, submit a claim or make a final coding decision.
Findings should be reviewed by appropriately qualified facility personnel before changes are made to the clinical record, MDS or claim.
This human-review step is intentional.
The strongest audit-defense position is documentation that can be explained and supported.
What Makes RevOptix1 Different?
Evidence-Oriented Review
Findings are tied back to the documentation available for review so your team can investigate the source rather than receiving a generic alert.
Skilled-Nursing Focus
RevOptix1 is designed specifically around skilled nursing documentation, reimbursement and audit-readiness workflows.
Revenue and Compliance Together
The same chart can contain both missed reimbursement opportunities and unsupported risk.
RevOptix1 is designed to surface both.
Cross-Chart Intelligence
Instead of looking only at one assessment field, RevOptix1 helps evaluate relationships across the available clinical record.
Human Expert Support
When a finding requires deeper human review, PDPM Audit Optimization Group provides an additional expert-services layer for SNF compliance and audit-defense support.
PDPM Audit Software vs. Manual Chart Review
Manual review remains important.
But manually reviewing every chart across a census is time-intensive.
RevOptix1 can help narrow the review by identifying records and issues that deserve closer human attention.
The combination is powerful:
Software finds the signal.
Experienced professionals determine what it means.
Common Issues a PDPM Review May Surface
Depending on the chart and documentation supplied, areas requiring review may include:
- primary diagnosis inconsistencies
- diagnosis-to-documentation discrepancies
- MDS/chart conflicts
- Section GG inconsistencies
- NTA documentation questions
- missing clinical support
- conflicting interdisciplinary documentation
- reimbursement-related discrepancies
- potential audit-readiness issues
- recurring documentation patterns
Every finding should be evaluated based on the applicable resident, assessment period and current guidance.
Prepare Before the Request Arrives
A MAC, RAC or other reviewer does not evaluate a chart based on what the facility intended to document.
The record has to support the services, assessment and claim under review.
Internal chart review gives your team an opportunity to identify weaknesses before external scrutiny.
RevOptix1 is designed to make that review more scalable.
Start With a RevOptix1 Pilot
See what RevOptix1 identifies in your own facility’s documentation.
The RevOptix1 Pilot gives your organization an opportunity to evaluate the platform using your own workflow and determine where chart intelligence can support your clinical, reimbursement and compliance teams.
Pilot pricing: $550 per month for the first three months.
Frequently Asked Questions
What is PDPM audit software?
PDPM audit software assists skilled nursing teams in reviewing clinical documentation, assessment information and reimbursement-related data for inconsistencies, missing support and items requiring additional review.
Does RevOptix1 automatically change the MDS?
No. RevOptix1 provides decision-support findings. Qualified facility personnel remain responsible for assessment, coding, documentation and billing decisions.
Can RevOptix1 identify missed reimbursement?
RevOptix1 can surface documentation that may warrant review for potential reimbursement implications, but the facility must determine whether the information meets applicable requirements and is appropriate to use.
Can RevOptix1 identify audit risk?
The platform can identify documentation gaps, inconsistencies and other items that may warrant compliance or audit-readiness review.
Does RevOptix1 replace PointClickCare, MatrixCare or another EHR?
No. RevOptix1 is designed as an additional chart-review layer that works from supported exports from existing clinical systems.
Who should use RevOptix1?
RevOptix1 is designed for skilled nursing administrators, MDS coordinators, clinical leaders, reimbursement professionals, compliance teams and multi-facility operators.
Does software replace human review?
No. RevOptix1 is intended to make human review more efficient by helping identify records and issues that deserve attention.
About RevOptix1
RevOptix1 is chart-intelligence software built for skilled nursing facilities.
The platform helps SNFs examine documentation, reimbursement and audit-readiness issues before those issues are discovered during external review.
Review before the auditor does.
CMS: Patient Driven Payment Model
This is a marketing page. Do not upload protected health information here. Chart review happens in the signed-in software after the applicable BAA path. RevOptix1 is decision-support technology, not auto-coding software.