CUSTOMER STORY
Skilled Nursing Facility Transforms MDS Assessment to Quickly Boost Revenue
The Challenge
Inaccurate Minimum Data Set (MDS) assessments can hinder skilled nursing facilities’ efforts to stay competitive (and solvent) in today’s post-acute market – and a basic MDS scrubbing tool is no longer enough to get the job done. These organizations need to be able to leverage real-time clinical data to improve resident care, boost reimbursements, and streamline quality management.
One large skilled nursing facility needed a way to improve revenue and ensure the highest levels of quality care under MDS requirements.
Leadership was concerned they were leaving money on the table by missing important documentation details with their current MDS scrubber software. They also wanted to potentially earn additional reimbursement by identifying trends in resident conditions that could trigger necessary interventions.
The Approach
The organization implemented Inovalon’s MDS Intelligence™ application at a 100-bed skilled nursing facility in Oregon in September 2022 and tracked its performance through December 2022.
The overall goal was to achieve more accurate MDS assessments and find untapped but justifiable revenue so they could earn higher reimbursements from resident documentation.
The Results
1,098 inconsistencies in MDS assessments were called out by logic flags across the five case-mix-adjusted payment components of the Patient-Driven Payment Model (PDPM) prior to submission.
811 instances in which resident care interventions could be appropriate and reimbursable were identified.
$9,278 in increased revenue over four months by earning $2.40 more per resident per day
Using MDS Intelligence
$335,530
additional potential revenue was located by implementing just 50% of the recommended interventions!
The Solution
MDS Intelligence helps SNFs across the U.S. make more informed care decisions and maximize reimbursements.
- Clinical watch pages
Track resident status trends - Logic flags
Ensure MDS integrity and accuracy - PDPM Calculator
Estimate reimbursements and IPA daily rates - Transmission watch
Transmit directly to CMS - Enterprise reporting
Overview of flags triggered, benchmarks, and MDS status
