Celtic Consulting



Celtic is a post-acute care advisory firm concentrated in clinical operations and regulatory compliance. Founded in Connecticut, it serves hundreds of clients nationwide as Regulatory and Operational subject matter experts and recognized by National, Regional, and State Professional Associations as innovative thought leaders. Celtic provides end-to-end guidance for Reimbursement and Regulatory matters, Clinical Performance and Enhancement initiatives, Patient Driven Payment Model (PDPM)/Minimum Data Set (MDS), and Case Mix Index (CMI), Billing services, Quality Improvement strategies, Compliance solutions, Medical Coding support and Litigation Support for Post-Acute Care. The firm values the unique qualities of clients and circumstances contributing to project goals. Recognized for building a solutions framework with the client from first contact through completion results in successful, integrated, sustainable outcomes.

Features and Benefits

Post-Acute Care Operations

Celtic’s scope of reimbursement and revenue services have guided Skilled Nursing Facilities nationwide to recoup millions of dollars in unrealized revenue. The firm’s accomplished Clinical Reimbursement specialists understand the detailed workings of the exceptionally regulated reimbursement process and recognize opportunities for improvement. The firm provides advisory services at all levels of Denials and Appeals with extensive knowledge of the MDS 3.0 RAI Manual, and the supportive documentation necessary has collected dollars even years after the initial denial. • Reimbursement and Regulatory Expertise • Revenue Integrity Audits • Monthly Claims Review • Clinical Meeting Oversight (Medicare Meeting, Triple Check Meeting) • Additional Development Request (ADR) Response • Interim Leadership Management • PDPM/MDS/CMI Training, Education, and Monitoring: o PDPM Partner Program, including Celtic’s proprietary PDPM Toolkit© o Clinical Reimbursement Staff Management o MDS Coordinator Training o Managed Care Case Management o MDS Auditing o Case Mix Index (CMI) Strategies and Oversight

Compliance Solutions

Celtic’s external analysis has served as an integral tool in managing regulatory compliance and avoiding potential fines and civil monetary penalties for hundreds of long-term care providers. Compliance program design, implementation, and evaluation form the cornerstone of our solutions, risk assessment, auditing, and monitoring, paired with investigation support and monitorship (e.g., Independent Review Organization, Board Advisor). • Compliance Solutions including Medicare Compliance Auditing: o Admission Document Verification o Medicare Program Integrity o Medical and Clinical coding including supportive documentation o Financial and Billing aspects o Managed Care/Medicare Advantage and other Insurance Entities • Provider Litigation Support for Post-Acute Care • Mergers and Acquisitions Due Diligence • Independent Review Organization (IRO) • Corporate Integrity Agreement Auditing and Reporting • Corrective Action Plan Development • Identification of Organizational Financial Risk Indicators • Rehab Documentation Compliance

5-Star Rating Improvement/Quality Improvement

Celtic’s success in enhancing Quality Improvement stems from introducing integrated, proven strategies for many organizations, targeted efforts on areas often yields a significant positive effect on the star rating and improving overall quality. Improved quality and top tier star ratings in part function as gateways for joining an Accountable Care Organization (ACO) along with other bundled partner projects. Our vast experience with the nuances of the Payroll Based Journal (PBJ) Reporting System positions us to offer leadership for improving facility metrics, typically following a rigorous analysis of what is currently in place. • 5-Star/Quality Measures Analysis • Quality Assurance Performance Improvement (QAPI) Plan Development • Payroll Based Journal (PBJ) Reporting Guidance • Rehospitalization Rate Reduction Strategies

Clinical Care Management

With concentration surrounding education, training and compliance, Celtic equips our partners with efficient processes and utilizes our expertise to identify opportunities for advancement in the quality of care they provide to their populations. Our collaborative approach results in tailored programs that aid organizations to establish reliable infection prevention protocols, achieve exceptional patient-care outcomes and implement survey preparedness strategies. • Implement Infection Prevention Protocols • Conduct Mock Survey Audits • Provide Clinical Performance and Enhancement Services • Train and Investigate Accidents & Incidents (A&I) • Clinical Program Assessment and Development: o Skincare planning o ADL care o Clinical documentation o Resident Assessment o Falls prevention o Discharge Preparedness (planning) o Care Planning o Full QAPI program evaluation o EMR and Interact Proficiency o Management and evaluation of changes to Requirements of Participation

Medical Coding Support and Billing Services

The Medical Coding and Billing Division provide comprehensive management of an organization’s accounts receivable and revenue collections for Federal and State insurers and private payors. • Medical Coding Services • Medical Claims Processing • Accounts Receivables Management • Revenue Cycle Management • Claims Denial

Partner Details

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