Our services — reimbursement

Medicaid Reimbursement
Optimization

Capture more of the revenue you've already earned through audit, appeal, and documentation process improvements. Many documentation and coding errors are correctable — often more than facilities initially recognize.

Our focus
Reimbursement and revenue cycle analysis
Rate and payer contract reviews
Documentation and billing process review
Revenue enhancement and denial prevention
Illustrative scenario, not a Ganavyx client result — hypothetical 120-bed skilled nursing facility. National rate figures below are cited separately.
Reimbursement audit — Q2 2024
$1.87M
Revenue recovered
This quarter
94
Claims appealed
78% success rate
Denial reasons — by volume
Insufficient documentation75.5%
No documentation3.8%
Incorrect coding0.3%
Other20.4%
Illustrative distribution for a 120-bed facility, not a cited external statistic
Medicaid improper payment rate
5.1%
of national Medicaid FFS & managed care payments — down from 8.6% in 2023
Source: CMS Payment Error Rate Measurement (PERM) Program, 2024
Recovery pipeline
Illustrative scenario — not a Ganavyx client result
Documentation correction
47 claims · In review
$682K
Formal appeal filed
31 claims · Pending
$448K
Rate adjustment
16 claims · Negotiating
$214K
Total recovery potential: $1,344,000
Total recovery potential
$1,344,000
Q3
Next audit review
—
What we do
Review revenue cycle, documentation, and billing
Revenue cycle and payer contract reviews
Documentation and billing process audit
Denial appeals and claim adjustments
The impact
Recover earned but uncaptured revenue
Strengthen cash flow and financial position
Reduce future denials through process fixes
Better billing and documentation practices
Who this is for
Skilled Nursing Facilities
Senior Living Operators
Multi-site Operators
Management Companies
Data sources
1 Centers for Medicare & Medicaid Services (CMS). Payment Error Rate Measurement (PERM) Program, Medicaid Improper Payment Rates, 2024. cms.gov/data-research/monitoring-programs/improper-payment-measurement-programs/payment-error-rate-measurement-perm

Proud member of leading industry associations

Member
LeadingAge NY
LeadingAge New York — serving New York's aging services community
leadingageny.org →
 Member
hfma
Healthcare Financial Management Association
hfma.org →
 Member
NYSHFA | NYSCAL
New York State Health Facilities Association · New York Center for Assisted Living
nyshfa-nyscal.org →

What to expect

A disciplined path from reimbursement review to practical action.

Ganavyx structures the engagement to help leadership identify reimbursement opportunities, documentation concerns, and process gaps without adding unnecessary burden to clinical and administrative teams.

Initial alignment

Discovery

We begin by understanding the facility's reimbursement priorities, current concerns, and where leadership believes revenue may be at risk.

  • ✓Recent reimbursement changes or concerns
  • ✓Documentation and coding workflows
  • ✓Known denials, delays, or missed opportunities
Your involvement
A focused leadership discussion and identification of key contacts.
Focused assessment

Reimbursement Review

Ganavyx reviews the available reimbursement, clinical, and financial information to identify material issues that warrant attention.

  • ✓MDS and supporting documentation
  • ✓Case-mix and reimbursement trends
  • ✓Denials, underpayments, and process controls
Your involvement
Provide requested records and answer limited follow-up questions.
Decision support

Executive Briefing

Leadership receives a concise, decision-ready package focused on the highest-priority reimbursement findings and practical next steps.

You receive
Executive SummaryA concise briefing of the most important reimbursement findings.
Opportunity RegisterPrioritized opportunities and issues requiring leadership attention.
Estimated Financial ImpactPotential reimbursement impact quantified where the available information supports it.
Action RoadmapRecommended priorities, responsibilities, and practical next steps.
As needed

Implementation Support

Ganavyx can remain involved to help leadership strengthen processes, address documentation gaps, and track financial results.

  • ✓Prioritization and action planning
  • ✓Documentation and workflow improvements
  • ✓Follow-up review and financial tracking
Flexible scope
Support is tailored to the facility's needs and internal resources.

Built for clinical and financial leaders.

The engagement is designed to produce clear financial direction while respecting the operational realities of reimbursement, documentation, and resident care.

✓Clear communication
✓Minimal operational disruption
✓Decision-ready recommendations
✓Practical next steps

Every engagement is tailored to the organization's priorities, available information, and operational objectives.

Capture more of what you've already earned.

Optimize reimbursement. Strengthen your bottom line.

Schedule a Consultation
Integrity·Insight·Growth