Medical RecordsIdentifying compliance gaps and fine-tuning the RAI process for optimal clinical reimbursement


To make improvements to an organization’s processes, it first takes a solid understanding of that facility’s strengths and needs. That’s why the Review step of Oversight Consulting Group’s multi-faceted approach is mission critical.

As facilities’ interdisciplinary team members have the responsibility of managing day-to-day operations, key procedures to meet continually changing state and federal rules and regulations for reimbursements can slip through the cracks. Without the time to give dedicated attention to the MDS/RAI process, it’s not uncommon for nursing homes and long-term care facilities to make unintentional errors and omissions in billing, coding and documentation that can result in the loss of Medicare and Medicaid funding.

We’ll be your partner in helping you meet all compliances through reviews that provide timely recommendations. Oversight Consulting Group treats every single organization with individualized attention. You have unique strengths and challenges. That’s why we fully customize our process audits and reports to address your specific needs.

Initial Review

To identify gaps that could cause deficits in clinical reimbursement (or even audits by the state or federal governments), we start with a thorough Review of your facility’s processes and procedures to create a baseline assessment. We do onsite interviews with your key staff members to uncover areas of concern or that warrant improvements. We also review medical records and gather essential information including current census data, past and present case mix index report numbers, and other data that directly impact your facilities Medicaid and Medicare reimbursement.


Upon completion of the initial review, we provide you with reports that detail our observations and recommendations for improving your processes. We offer practical, actionable steps that you can take to systematically implement change.

Ongoing Reviews

Because making improvements in itself is a process that evolves over time and requires dedicated attention, Oversight Consulting group performs ongoing reviews track your progress. We revisit your medical records and MDS/RAI process to update your reports and provide recommendations based on your most current compliance needs.


Below is a small sampling of the array of reports we create for our clients. We offer a variety of other reports in addition to these:

●     Case Mix Review

●     ADL Review

●     Therapy Minutes Review

●     Skilled Documentation Review

●     MDS Accuracy Review

●     Medicare Certifications/Recertification’s Review

●     Validation Reports Review

All reports are completed by the experienced clinician who performed your review. Unlike other companies who perform RAI process assessments and offer only canned “one size fits all” reports, we individualize all reports. This approach enables us to provide an accurate evaluation of your care facility’s compliance status, so we can provide recommendations and define actionable steps toward optimal Medicare and Medicaid reimbursements.


Contact us to discuss how we can help your facility improve its MDS/RAI process, obtain optimal clinical reimbursement, and avoid state and federal penalties for non-compliance.