Cost of Poor Quality Documentation Leading to Repayments and Revenue Loss

$1.2M - $3.5M annually (overpayment recovery + lost productivity) • $1.2M - $3.5M annually in VA claim denials (20-30% denial rate) due to documentation gaps; $200K-$400K in labor rework re-documenting for VA audits; delayed payments (45-90 day delays average) from documentation incomplete timelines • $1.2M - $3.8M annually per facility (lost PDPM revenue for unproven CNA hours)

Admissions Director completes initial assessment; Medicaid eligibility determination involves manual review of documentation by compliance staff; state Medicaid-specific assessment forms filled out separately from EHR; coordination via email/phone with state Medicaid case workers; paper-based medical necessity documentation compilation for Medicaid audits • Admissions Director conducts initial clinical interviews, documents in paper form or EHR; assessment data manually verified by MDS Coordinator for MDS submission; initial admission paperwork (diagnosis, past medical history) may not sync with nursing assessment; email coordination between Admissions Director and MDS Coordinator to resolve assessment discrepancies before submission • Billing and MDS data reconciled via manual Excel pivot tables; assessment data exported to CSV, manually matched against billing claims; email-based audit response documents; phone calls with plan auditors