CMS & OIG

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Nov 01 2025
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The Latest in the Lineup: The Skilled Nursing Facility Validation Program

The Centers for Medicare and Medicaid (CMS) audits of skilled nursing facility (SNF) Minimum Data Set (MDS) data are nothing new. The MDS 3.0 was implemented in 2010, and in 2014 CMS piloted MDS Focused Surveys in 5 states. The results of the pilot study prompted full implementation of MDS Focused Surveys nationwide, and these surveys continued through Fiscal Year (FY) 2017. Since then, CMS has instituted a different approach to reviewing MDS accuracy, and SNFs are now subject to a variety of...
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Oct 01 2025
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How the MDS is Utilized During the Survey Process

Have you ever wondered how the survey team determines which residents they will focus on during a standard survey in the skilled nursing facility/long term care facility (SNF/LTC)? The answers submitted to the Center for Medicare and Medicaid (CMS) on the Minimum Data Set (MDS) are a starting point for the survey process.   MDS USAGE The MDS is a versatile tool utilized as the beginning of individual resident care planning, contributing to a comprehensive facility assessment, driving...
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Sep 01 2025
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Fall MDS Updates are Here!

October 1 is typically when the Centers for Medicare and Medicaid Services (CMS) institutes changes to the Resident Assessment Instrument (RAI) and Minimum Data Set (MDS) – and this year is no exception. CMS has rescinded a few things that were anticipated and added a few things that may be a surprise. Post-acute care providers will want to make sure that staff are aware of the updates and have processes in place to ensure a smooth transition from September into October.   What Has CMS...
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Jul 01 2025
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The Facility Assessment and Emergency Management Planning: The MDS Plays a Big Role

  What is the MDS Role in the Facility Assessment? F838 in the State Operations Manual (SOM) provides specific information for developing a Facility Assessment that must be reviewed and updated at least annually. A well-developed facility assessment is a template that guides staff in determining what resources are necessary to care for residents competently during both day-to-day operations and in emergencies. Accurate data collected and recorded on the MDS can be used to generate helpful...
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Apr 01 2025
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MDS Errors: Steps for Correction

What does the NAC do when they identify an error on an MDS assessment? The answer is correct the identified error. Any error that incorrectly represents the resident's status needs to be corrected. One would think correcting an MDS error would be a “simple” process, but MDS corrections can be a multifaceted undertaking. When an MDS error is identified, the NAC must determine what type of error has occurred and if the MDS assessment has been submitted to iQIES (Internet Quality Improvement and...
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Mar 01 2025
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RAI and MDS Compliance: The Importance of the Administrator in the Lineup

With the Minimum Data Set (MDS), the Centers for Medicare and Medicaid (CMS) created a standardized, reliable, reproducible framework for assessing long term care resident status. As a result, MDS data plays a significant role in myriad areas of skilled nursing – from resident care plans to quality measures and reimbursement – which are governed through regulatory compliance. While adherence to these guidelines certainly falls to MDS Coordinators and Interdisciplinary Team (IDT) members, there...
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Aug 01 2024
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Internet Quality Improvement and Evaluation System (iQIES): A New Age

Just when we thought we had a handle on QIES (Quality Improvement and Evaluation System), the Centers for Medicare & Medicaid Services (CMS) transitioned to the Internet Quality Improvement and Evaluation System (iQIES) in 2023.   Reports and Roles Reports generated from MDS submissions (along with other reports) are available in the iQIES portal. Becoming familiar with what reports are available, who in the organization is responsible for “pulling” the reports, how often to pull the...
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Nov 04 2022
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Pillars of Care

Reviewing the Behavioral Health Pillars The US Department of Health and Human Services (HHS) developed a roadmap for behavioral health integration to address a national mental health crisis.  The current Administration's strategy is based on three core pillars: 1. Strengthen System Capacity 2. Connect Americans to Care3. Support Americans by Creating Healthy Environments While the HHS Roadmap does not specifically address Skilled Nursing Facilities, it requires efforts throughout the...
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Oct 07 2022
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MDS surprises fill new draft

Joe Bush | Oct 7, 2022 | Excerpted from McKnights Long-term care facilities, staff and more than half the states should prepare immediately for changes to the Minimum Data Set, experts said in early September. The Centers for Medicare & Medicaid Services released a draft of an update to MDS 3.0. Section G, used by many states to determine Medicaid reimbursement, is gone. The changes will be official in October 2023. Gloria Brent, president and CEO of MDS Consultants, told McKnight’s it was...
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Sep 07 2022
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MDS draft sends sector, states scrambling to assess effects

Joe Bush | Sept 7, 2022 | McKnights Long-term care facilities, staff and more than half the states in the US should start preparing immediately for extensive changes to the Minimum Data Set, resident assessment experts said this week. The Centers for Medicare & Medicaid Services last week released a draft of long-awaited update to MDS 3.0. Section G, used by many states to determine Medicaid reimbursement, is gone. Added were additional intake questions and a need for more robust...
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Jun 17 2022
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What’s New from CMS?

WHAT’S NEW FROM CMS? As the world tries to find a new normal, long-term care (LTC) professionals are watching what changes will come down from various White House initiatives. These initiatives to improve nursing homes include: CMS modifications for reimbursement and Continued changes related to COVID-19 reporting and care in the facilities. LTC professionals seeking to improve care, deal with staff crisis, and simple ways to implement required changes heard a recent talk by Ellen M. Berry, PT...
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Mar 03 2022
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Are You Paying Attention to Resident Discharge?

Are you Paying Attention to Resident Discharge? CMS & OIG Are In 2017, CMS put into effect the final rule that focused on discharge planning for residents from the nursing home setting. From monitoring deficiencies data, we know some facilities still do not follow current guidelines. What has become important when it comes to discharges? Discharge Planning Starts at Admission The discharge planning process is initiated on admission to the nursing home and requires a team effort involving...
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Feb 03 2022

OIG Report Cites Challenges

Top SNF Challenges from the OIG Report OIG released a report of the 2021 Top Management and Performance Challenges Facing the Department of Health and Human Services (HHS). The report from the Office of Inspector General (OIG) is titled, “2021 Top Management and Performance Challenges Facing HHS.”  It is worth a closer look at how this information will influence nursing home care.  This report keeps us informed on what federal organizations look at as they make future regulations for SNF's....
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Sep 06 2021
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Prepare Your Team for FY2022

The Updated SNF PPS Final Rule Skilled nursing facilities should be preparing now for these upcoming changes. This On August 4th CMS rule refresh: Updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for the fiscal year 2022 Updates the diagnosis code mappings used under the Patient-Driven Payment Model (PDPM) Implements a recently-enacted SNF consolidated billing exclusion, and Includes a discussion of a PDPM parity adjustment that...
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Aug 02 2021
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ICD-10 Coding and Guideline Updates for FY 2022

ICD-10 Updates Earlier this summer, the Centers for Medicare & Medicaid Services (CMS) released the ICD-10-CM code descriptions, tables and index, and addendum for the fiscal year 2022. Then on July 12th, the Official Guidelines for Coding and Reporting of ICD-10-CM became available online. The updated manual and guidelines for FY 2022 revealed 159 new codes, along with the Tabular and Index Addenda. Below is a summary of the changes that will most affect the Skilled Nursing Facilities...
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Nov 22 2020
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Five Star Updates

The Centers for Medicare & Medicaid Services (CMS) recently released the October 2020 version of the Five-Star Quality Measure System Technical Users' Guide. It includes several revisions and updates for the Staffing, Quality Measure, and Health Inspection ratings in response to the Public Health Emergency (PHE). Health Inspection Since the Nursing Home Compare (NHC) refresh in April 2020 and until further notice, the health inspection domain of the rating system is being held constant to...
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Sep 23 2020
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PDPM ICD-10 Mapping Changes Effective Oct 1, 2020

With the beginning of fiscal year 2021 October 1, there will be the expected changes to our MDS and billing processes. This year the number of changes is limited due to the unprecedented public health emergency we are experiencing with COVID-19.  Despite that, we can expect updates to the PDPM ICD-10 Mapping Tool this year. The following changes will be effective October 1, 2020: Certain Cancer ICD-10 Codes- Previously specific cancer diagnoses that could require a major surgical procedure did...
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Jul 22 2020
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Medicaid Changes Coming in October 2020

In late June, CMS addressed two issues and posted MDS 3.0 Final Item Sets (V1.17.2).  The two edits were changes to facilitate the calculation of Patient-Driven Payment Model payment codes on OBRA assessments for states that wish to have this calculation performed.  These two edits will be revised and go into production on October 1, 2020. The purpose of these changes?  To allow State Medicaid Agencies to collect and compare RUG-III/IV payment codes to PDPM ones and thereby inform their future...
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Jun 01 2020

Isolation and COVID

Many providers have have cohorted residents in the same isolation room - applying recent CMS and CDC guidance during the COVID-19 emergency. This cohorting leaves many providers with the question: Can we code isolation on the MDS for cohorted residents? These facilities recognize that coding isolation will result in higher reimbursement in the PDPM, State case-mix, and Medicare Advantage payment models.  However, residents with COVID-19 may or may not meet the requirements for coding defined...
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May 18 2020

Section 1135 Waivers

When the President and HHS Secretary declared a national health emergency in response to the COVID-19 pandemic, they triggered section 1135 of the Social Security Act.  Section 1135 allows the Secretary to temporarily waive or modify certain Medicare and Medicaid requirements to ensure sufficient health care for enrollees. Skilled Nursing Facilities (SNFs) were issued multiple blanket waivers. 3-Day Prior Hospitalization waiver- waives the 3-day inpatient hospital stay requirement Spell of...
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Recent Blogs in All Topics

Nov 01 2025
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The Latest in the Lineup: The Skilled Nursing Facility Validation Program

The Centers for Medicare and Medicaid (CMS) audits of skilled nursing facility (SNF) Minimum Data Set (MDS) data are nothing new. The MDS 3.0 was implemented in 2010, and in 2014 CMS piloted MDS Focused Surveys in 5 states. The results of the pilot...
Keep Reading
Oct 01 2025
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How the MDS is Utilized During the Survey Process

Have you ever wondered how the survey team determines which residents they will focus on during a standard survey in the skilled nursing facility/long term care facility (SNF/LTC)? The answers submitted to the Center for Medicare and Medicaid (CMS)...
Keep Reading
Sep 01 2025
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Fall MDS Updates are Here!

October 1 is typically when the Centers for Medicare and Medicaid Services (CMS) institutes changes to the Resident Assessment Instrument (RAI) and Minimum Data Set (MDS) – and this year is no exception. CMS has rescinded a few things that were...
Keep Reading
Aug 01 2025
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Medicaid PDPM Is Coming: What Skilled Nursing Facilities Need to Know

Beginning October 1, 2025, many nursing homes will adopt a new reimbursement model for Medicaid residents: the Patient-Driven Payment Model, or Medicaid PDPM. While PDPM has been in place for Medicare since 2019, this is the first time it’s being...
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Jul 01 2025
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The Facility Assessment and Emergency Management Planning: The MDS Plays a Big Role

  What is the MDS Role in the Facility Assessment? F838 in the State Operations Manual (SOM) provides specific information for developing a Facility Assessment that must be reviewed and updated at least annually. A well-developed facility...
Keep Reading
Jun 01 2025
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MDS Nutrition – Not Limited to Section K

Often Section K on the MDS, associated CAAs, and care planning are relegated to the dietician to worry about. However, when we look at a comprehensive MDS, we can see that the information in Section K is only part of the resident's nutritional...
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May 01 2025
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Celebrating Skilled Nursing

National Skilled Nursing Week is held annually in May to recognize long-term care professionals that care for our residents in Skilled Nursing Facilities. This year’s National Skilled Nursing Week is May 11 - 17 and the theme is “Tapestry of Life”...
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Apr 01 2025
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MDS Errors: Steps for Correction

What does the NAC do when they identify an error on an MDS assessment? The answer is correct the identified error. Any error that incorrectly represents the resident's status needs to be corrected. One would think correcting an MDS error would be a...
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Mar 01 2025
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RAI and MDS Compliance: The Importance of the Administrator in the Lineup

With the Minimum Data Set (MDS), the Centers for Medicare and Medicaid (CMS) created a standardized, reliable, reproducible framework for assessing long term care resident status. As a result, MDS data plays a significant role in myriad areas of...
Keep Reading
Feb 01 2025

Laying the Foundation – Care Area Assessments to Care Plans

Because Care Area Assessments (CAAs) are not submitted to CMS, and the Resident Assessment Instrument (RAI) manual offers little guidance on how to complete a CAA when compared to the Minimum Data Set (MDS) instructions, CAAs are a segment of the...
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Jan 01 2025

Navigating the 2025 Winds of Change: New Survey Guidance

The 2025 new year has begun with a whirlwind of changes in Long-Term Care – starting with New Surveyor Guidance. CMS released an advanced copy of these State Operations Manual Appendix PP (Guidance for Skilled Nursing Facilities) updates in a...
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Dec 01 2024
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What is an MDS Coordinator?

"What do you do for a living?" It may not surprise you that when asked this question, most MDS Coordinators struggle to come up with an answer. The reality is that MDS Coordinators fully understand what this multifaceted job entails, but are at a...
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Nov 01 2024
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From the MDS to RAI System Management

With the introduction of the Minimum Data Set (MDS) through the Omnibus Budget Reconciliation Act (OBRA) of 1987, Centers for Medicare and Medicaid (CMS) implemented a method of standardized, comprehensive, and reproducible data collection for long...
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Oct 01 2024

Maximizing Case Mix with Special Programs: Respiratory Therapy and Restorative Nursing

Case mix is essential in skilled nursing facilities as it impacts both reimbursement and the care provided. Two key programs that significantly impact case mix scores when properly implemented and documented are Respiratory Therapy and Restorative...
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Sep 01 2024

Strategic Admissions: The Path to Optimized Medicaid Reimbursement

Medicaid reimbursement plays a significant role in the financial health of long-term care facilities, particularly those serving a high percentage of Medicaid residents. While it may not be the sole source of revenue, it is an important component...
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Aug 01 2024
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Internet Quality Improvement and Evaluation System (iQIES): A New Age

Just when we thought we had a handle on QIES (Quality Improvement and Evaluation System), the Centers for Medicare & Medicaid Services (CMS) transitioned to the Internet Quality Improvement and Evaluation System (iQIES) in 2023.   Reports...
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Jul 01 2024
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A Significant Change in Status Assessment – There are Options

The Resident Assessment Instrument (RAI) system includes a significant change in status assessment (SCSA). What might be forgotten is the State Operation Manual (SOM), Appendix PP, includes information that mirrors the RAI manual at 42 CFR...
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Jun 01 2024
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Interim Payment Assessment (IPA) – To do or not to do?

The Patient-Driven Payment Model took effect in October of 2019. Along with this change came the optional IPA. We are now five years into this change and questions still arise on when to complete an IPA. The decision of when to complete lies with...
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May 01 2024
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Resident Interviews – What are you doing to capture the data?

Effective October 1, 2023, several resident interviews were added to or updated on the MDS. Interview items in Section A and changes to the interviews in Section D, J, and Q have been implemented. Each of the interviews can be a great steppingstone...
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Apr 01 2024
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Section GG Documentation – Questions Still Abound

Section GG remains a popular discussion topic among the Nurse Assessment Coordinator (NAC) and other members of the interdisciplinary team (IDT). Many have questioned their own practices and processes, designed to support coding this section of the...
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Mar 01 2024
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Social Determinants of Health (SDOH) – A Global Initiative Important to Skilled Nursing Providers

The Centers for Medicare & Medicaid Services’ (CMS) Office of Mental Health report CMS Framework for Health Equity 2022 and 2032 states that health equity is defined by the attainment of the highest level of health for all people, where...
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Feb 01 2024

Trauma and the MDS – A Sneak Peak

Trauma informed care has become an area of focus for Post Acute Care providers and survey agencies. Organizations are required to provide trauma-informed care that meets “professional standards of practice and accounting for residents’ experiences...
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Jan 01 2024

New Year….Same MDS Obstacle Course

As we ring in 2024, long term care professionals are still struggling to implement the October 2023 updates to the MDS. CMS is already talking about more changes in 2024, and the anticipation continues to create anxiety amongst PAC members. While...
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Dec 01 2023
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Schizophrenia Diagnosis Audits

On January 18th, 2023, CMS announced they will be conducting off-site audits in nursing homes for assessment accuracy and coding of residents with a diagnosis of Schizophrenia. Along with auditing for appropriate diagnosis, the audits will review...
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Nov 01 2023
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OSA or PDPM? A State-Level Decision

As of Oct. 1, 2023, the Centers for Medicare & Medicaid Services (CMS) has retired the A0300 Optional State Assessment (OSA) from the federally required MDS 3.0 v1.18.11 that is submitted by nursing facilities. The OSA is now a separate...
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Oct 02 2023

The Physician and “I”

The physician’s role in the nursing facility is essential to delivering skilled, quality care for Skilled and Long-Term Care residents. Physicians are our lead in providing clinical decision making and properly defining, clarifying, and verifying...
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Oct 01 2023

Coding UTIs on the MDS 3.0

Urinary Tract Infections (UTIs) are a commonly miscoded data element on the MDS. Are you over coding UTIs? Are you not coding them at all? Should you? Shouldn’t you? The MDS has historically left data collectors asking themselves these questions....
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Oct 01 2023
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Achieving Accurate ADLs with the OSA

Section G of the MDS 3.0 was retired October 1, 2023, yet the MDS nurse may still need to use the knowledge of accurately coding ADLs with an assessment called the Optional State Assessment (OSA).  State-Optioned OSA Although the option to choose...
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Jul 05 2023

What Is an MDS Coordinator?

It’s a bit odd that when asked what you do for a living most MDS coordinators struggle to come up with an answer. Who struggles to explain what they do every day? The reality is that MDS Coordinators fully understand what this multifaceted job...
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May 13 2023
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MDS 2023 Countdown Wrap-Up

This post is part of the MDS 2023 Countdown series.  Disclaimer: Current as of May 13, 2023.   What You Can Expect to See CMS released the first MDS draft item set (v1.18.11) in September 2022, which generated many questions for the long-term...
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