Accountable Care Organizations

RUG-based reimbursement under the ACO model requires accurate scoring of the MDS assessment to represent the appropriate clinical condition and services rendered to the patient.

Harmony Healthcare International, Inc. (HHI) provides operational review of Medicare Skilled Coverage Criteria and the proper application to Accountable Care Organization beneficiaries. Our HealthCARE Specialists provide education and training to staff to assist in reducing re-hospitalization, managing clinically anticipated length of stay, discharge planning and outcomes measurement. We assist facilities in ensuring that quality measures and Five-Star rating accurately reflect quality of care provided.

How can Harmony Healthcare International, Inc. (HHI) help?

The key elements of our services include on-site visits that focus on the following: 

  • Orchestration of establishing a diversified team to understand and monitor the ACO regulations and analyzing the impact on your organization.
  • Review of existing relationships with hospitals and/or physician groups that are ACO partners. 
  • Review of IT infrastructure for population management, care coordination and monitoring, managing and reporting quality outcomes.
  • Assisting the SNF’s role of presenting how operation of the post-acute care setting adds value to the ACO
  • Understand how existing or proposed quality performance measures might be used by providing assistance with developing quality performance measures against established benchmarks
  • Education to develop a process to continually monitor and improve performance for various quality measures.
  • Develop a strategy to enhance existing strategies for handling post-acute care ACO patients
  • Plan documentation review for consistency between Medicare Skilled Coverage Criteria, Affordable Care Organization Policy and Procedures, and ACO plan requirements. This includes all facets such as centralizing costs, measuring results, marketing services and maintaining relationships
  • Monthly Medicare Clinically Anticipated Stay Analysis
  • Access to Harmony HealthCARE Specialists
  • Monthly reporting mechanism to with follow-up tools and recommendations
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