We’re now well past the one-year mark of the shift from RUGs to the patient driven payment model (PDPM), which means it’s probably time for an annual checkup. And if you’ve already been researching ways to fine-tune your efficiencies and maximize your results, you’ve probably come across terms like MDS scrubbers and data audits.
Effectively utilizing one of these tools can be a game-changer when it comes to improving data accuracy, ensuring compliance, and achieving the reimbursement for the care you provide.
What is an MDS Scrubber and is it Important?
The minimum data set (MDS) assessment is the standardized and federally mandated clinical assessment of patients in your facilities that serves as the basis for the assessment and care planning process. For many patients, it also determines how much you’ll be reimbursed for their care.
As your MDS Coordinator and interdisciplinary team complete the MDS, it’s critical that the data coded on the assessment is complete and accurate. Identifying errors, catching missed conditions, and correcting inconsistencies in real-time can make a significant difference in reimbursement rates. And an accurate assessment is crucial for a comprehensive and individualized patient care plan.
An MDS scrubber can help, checking each of your MDS assessments prior to submission to the Centers for Medicare and Medicaid Services (CMS). Many scrubbers use the CMS validation edits to ensure data on the MDS is in the proper format, all required fields have been completed, any “skip patterns” of MDS items are correct, and date items make logical sense.
Taking MDS Scrubbing to the Next Level
MDS scrubbing is a great place to start. However, for those SNFs looking to truly change the game, Data Integrity Audit (DIA) is a much stronger approach. Not only does DIA check for the basics like a scrubber does, it provides feedback on MDS coding from clinical, regulatory, financial, and risk management perspectives.
MDS coding errors and coding inconsistencies are identified, along with alerts to quality measure and reimbursement issues that need to be reviewed before submitting the assessment to CMS. By using a much more comprehensive and analytics-driven approach, you’re setting your team up for success.
Some of the benefits of DIA include:
- More accurate reimbursement
- Improved quality measures
- More individualized care planning
- MDS coding support for your team members
- Compliance check by a third party outside your EHR software
Additionally, DIA provides guidance and recommended actions to address identified issues. It helps to build a practical learning and feedback loop to drive continuous improvement for your team. Identifying issues is step one; knowing how to correct them is where you find the greatest benefits.
Is the more in-depth audit worth it? Check the numbers.
Here are some highlights from the facilities using the DIA solution offered by PointRight, a Net Health data analytics company:
- Average Medicare Part A per diem rate increase of $4.16 per day (an additional of at least $50,000 per year for a typical facility)
- 12% fewer total health inspection deficiencies
- 6% reduction in total health inspection deficiencies on the first survey after implementation
- Users who stopped using the solution saw an average of a 3% increase in the total number of deficiencies and a 25% increase in immediate jeopardy deficiencies on their first inspection afterwards
*All statistics are on average
The numbers are clear that implementing a DIA can bring marked and measurable results—and fast. It fits easily and seamlessly into your team’s existing MDS workflow and provides them with the decision support they need to give your facility a clear advantage with PDPM reimbursement and quality outcomes.