(The following is an advertorial exploring the work of Park Place sponsor and thought leader R2 – Reimbursement Reimagined, a division of Zimmet Healthcare Services Group employing more than 300 staff. R2 offers remote MDS and case management solutions for accurate Medicare, Medicaid, and Medicare Advantage reimbursement. Amy Goldsmith, chief operating officer, leads the group.)

To tell us about R2 in a more in-depth way, and to offer tips for SNFs on what exactly they can do to enhance their reimbursement portfolio, we are joined by Katy O’Connor, vice president of case management services, and Michele Stern, director of clinical education and training.

Park Place: Welcome. Can you tell us who your customers are?

R2: We primarily partner with SNFs to support a broad range of managed care operations, including subacute care, long-term care, outpatient/Part B services, prior authorizations, and retroactive authorizations for managed care beneficiaries. In addition, we provide authorization management services for home health clients.

Our team offers flexible, à la carte solutions tailored to each organization’s needs, with both short-term and long-term case management coverage options available.

Park Place: What are the goals for your case management assignments?

R2: We work to alleviate the administrative burden associated with day-to-day management, tracking, and submission of managed care authorizations and extension requests for facilities. By functioning as a seamless extension of each organization’s team in a remote capacity, we help streamline operations while enhancing efficiency and reimbursement outcomes.

Our focus is on optimizing reimbursement opportunities and supporting appropriate length of stay determinations for subacute patients covered under managed care plans, while securing the highest clinically appropriate level of authorization for each patient. We also have a strong track record of successfully recovering retroactive authorizations that might otherwise result in lost revenue.

In addition, we support cleaner billing practices and more accurate claims management to help reduce denials, improve revenue cycle performance, and strengthen overall operational outcomes.

Park Place: Any tips on how to boost reimbursement?

R2: Facilities should maintain a strong understanding of their managed care contracts and leverage interdisciplinary team meetings to comprehensively review the care and services being provided to patients. Utilization management discussions are most effective when interdisciplinary teams collaboratively evaluate treatment goals, clinical progress, and barriers to discharge to ensure alignment across all disciplines involved in patient care.

Additionally, ensuring that clinical documentation accurately reflects the services provided, the patient’s treatment goals, and any ongoing discharge barriers is critical. Comprehensive and consistent documentation supports a clearer understanding of the patient’s clinical needs for external reviewers, while also strengthening care coordination, authorization support, and reimbursement outcomes.

Park Place: Has technology changed what you do since R2 started in 1993?

R2: While we continue to explore the integration of AI-driven solutions, our current technology platform enables us to effectively track and visualize authorization activity in real time and longitudinally across the hundreds of facilities we support. This level of data visibility allows us to identify trends within individual facilities, across specific payers, and throughout multiple states and markets.

Our work combines detailed clinical and operational analysis—including comprehensive chart reviews and documentation audits—with advanced tracking and trend monitoring capabilities. By identifying shifts in payer behavior, market conditions, and authorization patterns, we are able to proactively adapt strategies and provide informed, data-driven support to our clients.

Park Place: Which payer gives the most room for correcting oversights by customers?

R2: Leveled reimbursement contracts often present the greatest opportunities for reimbursement optimization; however, our expertise extends beyond contract structure alone. Through our work with payers across multiple states and markets nationwide, we are able to provide clients with valuable insight into payer-specific workflows, authorization patterns, and utilization management strategies that support appropriate length of stay optimization and improved reimbursement outcomes.

Additionally, we provide ongoing internal support and guidance to staff in the areas of denial management, appeals management, and retroactive authorizations—areas that frequently represent overlooked reimbursement opportunities. Our approach helps strengthen revenue recovery efforts, improve operational efficiency, and ensure that potential sources of reimbursement are thoroughly identified and pursued.

Finally, we provide our clients with comprehensive case management coverage 7 days a week, 365 days a year—an increasingly critical service as managed care insurers continue to expand toward seven-day authorization and utilization review operations. This continuous support helps ensure timely communication, uninterrupted authorization management, and consistent oversight of patient cases to support optimal clinical and reimbursement outcomes.

Park Place: Have there been any regulatory changes that have affected your work?

R2: With the recent CMS final rule mandating more timely authorization determinations by managed care organizations—reducing decision time frames from 14 days to 7 days—many insurers are expanding utilization management operations into weekends. As a result, there is an increasing expectation for clinical updates, authorization submissions, and denial management activities to be completed on a seven-day basis, including weekends, to ensure compliance with accelerated review timelines and uninterrupted care coordination. 

Questions or comments? Contact Patrick Connole at pconnole@parkplacelive.com.