MEDICARE PART A · PDPM
Find the documentation gap before the auditor does.
Predisight analyzes MDS assessments and clinical documentation to surface where a Part A claim isn’t yet supported by the record — before it’s submitted. Deterministic rules. Cited findings. Reviewed by your clinicians, decided by your clinicians.
Built by clinicians who spent years in these charts.
Divider Element
THE PROBLEM, IN NUMBERS
$4.3B
SNF IMPROPER PAYMENTS · FY2025
$2.31B
TRACEABLE TO INSUFFICIENT DOCUMENTATION
5 CLAIMS
REVIEWED AT EVERY SNF UNDER THE CMS PROBE
Source: CMS Comprehensive Error Rate Testing, FY2025.
The problem
A denial is rarely about the care.
Medicare does not pay for skilled care. It pays for skilled care the record proves. A reviewer never sees your building — only what was written down.
Progress note · Day 4
Resident up in chair this shift. Tolerated well. Encouraged PO intake. Wound to sacrum observed, dressing intact. Will continue to monitor.
Illustrative — synthetic
What a reviewer looks for
The care may well have been skilled. The note does not say so.
01
The gap surfaces after it can be closed.
Denials, ADRs, and prepayment review arrive months later. The correction window shut long before the letter did.
02
One claim is never one claim.
A denial is the write-off plus the cost of appeal. A prepayment review is every claim in the building, held at once.
03
Review capacity is already spent.
Your MDS coordinator is reconciling assessments against charts by hand, on a deadline, at volume. She will catch what time allows.
ARCHITECTURE. hiding
The model reads. It doesn't decide.
Most healthcare AI hands you a conclusion and asks for trust. Predisight hands you the reasoning.
Reads the narrative. Reports what the note says, in fields it cannot exceed.
Owns every rule, score, and verdict. Same chart, same finding, every time.
Decides. Always. The system has no authority to act.
Every finding traces to a rule and a citation. If you want to see the logic, we will walk your team through it line by line.
PLATFORM
What it checks.
HIPPS DEFENSIBILITY
Every character of the billed classification, checked against what the record actually supports. Component by component.
RULE-BASED DOCUMENTATION REVIEW
Wound care, respiratory, complex medical treatments, therapy and SLP note sufficiency. Each anchored to CMS manual or LCD authority.
MDS-TO-CHART RECONCILIATION
Coded items read directly and reconciled against the narrative record, section by section.
COPY-FORWARD DETECTION
Duplicated narrative, blank GG items, missing assessments, and internal contradictions — surfaced for review.
NTA DOCUMENTATION COMPLETENESS
Conditions being actively treated but absent from the coded record, flagged as documentation gaps.
CITED FINDINGS
Every finding carries its authority: CMS Benefit Policy Manual, RAI Manual, 42 CFR, or the applicable MAC LCD.
EARLY ACCESS
See what your record supports.
We are working with a small number of facilities to test findings against real audit history. Send us a stay you have already been paid for. We will tell you what a reviewer would have found.