Back in 2019, the Centers for Medicare & Medicaid Services (CMS) rolled out the Patient Driven Payment Model (PDPM) with the goal of better aligning payment rates with the costs of care by taking a value-based approach to reimbursement.1 And since reimbursement is now primarily based on the medical complexity of the patient, it’s imperative to get MDS assessments right to correctly capture compensation.
While many SNFs and healthcare organizations planned to use 2020 to get a good grip on PDPM training and value-based care, the COVID-19 pandemic had other plans, postponing a lot of that work. But as we start to come out the other side of the pandemic and transition out of reactionary postures to proactive ones, it’s time to get back on track.
In this article, we’re going to look at three great strategies for mastering the MDS assessment to offer the highest level of care management to patients and to ensure proper reimbursement.
1. Align Timing of an MDS Assessment to Ensure Reimbursement
Under PDPM, the non-therapy ancillary (NTA) component of reimbursement is tripled during the patient’s first three days.2 NTAs are conditions or comorbidities that add to a patient’s medical complexity, including things like opportunistic infections, HIV, and morbid obesity.
And with patients being the sickest when they’re first discharged from the hospital, the timing of the MDS assessment becomes critical to capture these additional conditions or comorbidities. If the assessment is delayed, conditions you treated may no longer be evident or the assessment may get rushed leading to missed opportunities.
Have a plan in place to logistically handle the MDS assessment in a timely manner.
For more information on PDPM, consider reading our free e-book—PDPM Rate Driver Data Shows How SNFs Performed in 2020
2. Upgrade from an MDS Scrubber to a Data Integrity Audit (DIA) Tool
SNF software and healthcare analytics tools can do quite a bit to have a team’s back. One of the more commonly utilized tools is an MDS scrubber that checks MDS assessments prior to submission to CMS for errors, missed conditions, or any other inconsistencies that could affect reimbursement.
But a step higher in the technology support hierarchy to consider is a Data Integrity Audit (DIA) solution. Not only do these tools handle everything you get with an MDS scrubber, but they go further to offer data-driven feedback from clinical, regulatory, financial, and risk management perspectives. It’s a fantastic next step for an organization looking to better its care management operations across the board.
For more information on this, consider reading—Rub-a-dub-dub – More than a Scrub! Mastering the MDS for SNFs.
3. Have a Plan to Mitigate Adverse Events
One of the most impactful factors on treatment costs and patient success is adverse events. When patients fall, develop pressure ulcers, face rehospitalization, or have any other unexpected negative event, it’s never a good thing.
But thanks to the growth of predictive analytics in healthcare, these “unexpected” events don’t have to be so unexpected. Existing MDS systems are already collecting data that can be used to identify higher-risk patients. Once identified, care management teams can develop plans of action to mitigate risk and to get friends and family on the same page of what to expect and how they can help.
Actionable steps for harnessing the power of MDS-based insights.
If you’d like to learn more about how to use MDS assessments to improve patient care and strengthen the bottom line, we’d encourage you to check out our free e-book—The Power of Leveraging MDS-Based Analytics to Improve Patient Care.
- Centers for Medicare & Medicaid Services (CMS), https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/PDPM, June 14, 2021.
- Centers for Medicare & Medicaid Services (CMS), https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/MLN_CalL_PDPM_Presentation_508.pdf, June 14, 2021.