How To Get A Fair Reimbursement Rate


Your organization is made of highly trained, hardworking, caring individuals that meet your residents’ ongoing and post-acute needs. Your residents are happy, fulfilled, and well cared for. Well done! Now it’s time to make sure you are being fully and fairly compensated for all the effort you and your staff are putting into resident satisfaction. Over the years, our LeaderStat healthcare recruiters and consultants, who routinely work with skilled nursing centers to maximize Medicare and Medicaid reimbursement rates, have found several common problem areas that result in facilities leaving money on the proverbial table. Those in the industry won’t be surprised to know the biggest problem area is the Minimum Data Set (MDS) assessment. Here’s how to improve it:


The most miscoded section of the MDS is the Activities of Daily Living (ADL). This is significant as it is a major component of RUG and CMI score calculations. The areas of weakness here tend to be in how quantity and quality of ADL coding is being monitored, how often a whole house caregiver training on ADL definitions, case scenarios, and coding tips occurs, and a lack of condensed training on this topic during new hire orientation.


Don’t underestimate the importance of choosing an adequate Assessment Reference Date (ARD). It is vital to maximizing reimbursement rates. The MDS process is complex, to say the least, and a lack of a strategic plan in this area leads to inadequate reimbursement. Particular consideration must be given to who sets the ARDs in your facility, and what information is being taken into consideration when the ARD is selected.


MDS nurses MUST be in the loop. Always. Even minor resident acuity changes must be communicated. Is there a strategy for this? Do your MDS nurses have a system to monitor and track such information? Are they seeking it out? Or are members of the team currently functioning as silos? The importance of having a reliable system in place here cannot be stressed enough.

We would love to help you make sure your staff fully understands how reimbursement rates are impacted by the MDS, and help your facility put systems in place to create a complete and robust MDS process.

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LeaderStat specializes in interim leadership, executive recruiting, and consulting for healthcare organizations.