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The MDS assessment: Three steps to higher quality care and reimbursements

How confident are you that your skilled nursing facility (SNF) has captured all earned reimbursement for each resident? Complete, accurate, and timely resident assessment data are critical to ensuring high-quality care and maximizing reimbursement.

The minimum data set (MDS) is a standardized assessment used by SNFs to collect and document clinical data on their residents. The Centers for Medicare & Medicaid Services (CMS) uses this data as a basis for quality measurement, public reporting, and to determine reimbursement. Additionally, the MDS assessment serves as an important tool for developing individualized care plans, tracking resident progress over time, and monitoring quality performance.

In today’s post-acute market, a basic MDS scrubbing tool is no longer enough to get the job done. Here are three steps your organization can take to deliver higher quality care and increase reimbursements.

1. Bridge the gaps in your documentation

Manual documentation and time constraints are common challenges for nurses, leading to delayed assessments and documentation gaps. Inaccurate and missing data on MDS assessments mean your facility may not receive reimbursement commensurate with the care provided.

SNFs can bridge these gaps by adopting MDS assessment software that analyzes MDS items – for example, by reviewing admission and discharge documentation and comparing ICD-10 codes for the clinical and non-therapy ancillary (NTA) diagnoses – to verify they comply with resident assessment instrument (RAI) guidelines and adhere to best practices. By ensuring all areas of the MDS are complete and accurate, the data can better contribute to managing residents’ clinical outcomes.

2. Ensure MDS accuracy

With nursing homes increasingly under the microscope, you can’t afford to get the MDS wrong. Inaccurate MDS assessment documentation puts your facility at risk for:

    • Regulatory noncompliance
    • A CMS audit
    • Decreased quality of care
    • Delayed reimbursement
    • Reduction in your five-star rating.

A sure-fire way to get it right is with an MDS assessment solution that uses a series of logic checks to call out any inconsistencies in your MDS assessment before submission, so you can make the appropriate corrections, compile justification documents, and be survey-ready.

3. Move beyond a basic MDS assessment scrubber

Taking MDS scrubbing to the next level can help SNFs overcome some of the biggest challenges they face today. To compete in today’s value-based healthcare environment, facilities need to take a proactive approach to identify needed care interventions. That requires an accurate and objective analysis of their quality and outcomes data so nursing staff can make informed care decisions.

Healthcare analytics tools can help your care team dig deeper to:

    • Identify trends in resident conditions that could trigger necessary interventions
    • Create more individualized care plans
    • Drive continuous performance improvement
    • Find untapped justifiable revenue

Ready to transform your MDS assessments?

Discover how an Oregon SNF improved quality of care and stopped leaving money on the table by implementing Inovalon’s MDS Intelligence software to transform their MDS assessment process.


Inovalon and design® and Inovalon® are trademarks of Inovalon, Inc.

By Inovalon