Efficiency - Accountable Care Organizations 


Harmony Healthcare International (HHI) provides operational review of Medicare Skilled Coverage Criteria and its 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.  RUG-based reimbursement under ACOs requires accurate scoring of the MDS assessment ensure the appropriate representation of the clinical condition and services rendered to the patient.

Skilled Nursing Facility operational reviews include:

  • Medicare Skilled Coverage Criteria and its proper application to Accountable Care Organization beneficiaries.
  • Initiate the provider management process to collaborate with the ACO provider(s).
  • Strengthen internal policies & procedures.
  • Understanding the partnership of coordinating ACO beneficiary and delivering skilled services.
  • Process review of skilled documentation to support case management of ACO beneficiaries.
  • Clinical Case Management from admission to discharge.
  • In-service education and training to staff, as needed, to include such topics as:
  • Preventing Hospital Readmissions
  • Clinically Anticipated Stay
  • Skilled Documentation and Discharge Planning
  • Outcomes Measurement

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