MEDICARE PART A · PDPM
Catch documentation gaps 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, led by a PT and RAC-CTA with 10+ years in skilled nursing.
Divider Element
Triple check covers the billing. Auditors review the chart.
✓
Claim matches
the MDS
✓
Dates, payer, and HIPPS line up
✗
Chart supports what was coded
Source: CMS Comprehensive Error Rate Testing, FY2025.
The problem
A denial is rarely about the care.
Medicare pays for skilled care that's documented. Claim reviewers judge your care by what's in the chart.
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01
Audits show up months later
Denials and ADRs arrive long after billing, when it's too late to fix the chart. Predisight flags gaps before triple check, while your team can still act.
02
One denial can cost more than one claim
You lose the payment and pay for the appeal. Prepayment review can hold claims across your whole building.
03
No one has time to read every note
Your MDS team is reconciling assessments by hand, on deadline. Predisight identifies the primary diagnosis the record supports and shows where the chart backs each coded item, so they spend their time on the gaps instead of hunting for evidence.
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 Predisight checks
Primary diagnosis and HIPPS
Confirms the record supports the primary diagnosis and each component of the billed HIPPS.
MDS vs. chart
Checks coded items, including GG and NTA conditions, against the clinical record. Flags gaps in both directions.
Note quality
Reviews wound care, respiratory, complex medical, and therapy notes against CMS documentation standards.
Red flags
Catches copy-paste notes, blank items, missing assessments, and contradictions.
EARLY ACCESS
Try Predisight on your next triple check
We’re working with a small number of facilities before general release. Pick a stay you’re about to bill, and we’ll have findings back before your meeting. Already been through an ADR? Send us that stay and see whether we’d have caught it.