News for MDS Experts

𝗙𝘂𝗻 𝗙𝗮𝗰𝘁: 𝗗𝗶𝗱 𝗬𝗼𝘂 𝗞𝗻𝗼𝘄...?

Before hospitals and health systems jumped on the digital bandwagon, nursing homes were already leading the way in clinical data collection.

That’s right, with the introduction of the Minimum Data Set (MDS) in the early ‘90s, nursing homes became early adopters of standardized, federally mandated digital assessments.

This was before EHRs were even common in most hospitals.

𝗧𝗵𝗲 𝗠𝗗𝗦 𝗯𝗲𝗰𝗮𝗺𝗲 𝘁𝗵𝗲 𝗳𝗼𝘂𝗻𝗱𝗮𝘁𝗶𝗼𝗻 𝗳𝗼𝗿:
- PDPM
- Quality Measures (QMs)
- Five-Star Ratings
- Survey risk indicators
- Resident-centered care planning
- And, of course… Medicare reimbursement 💰

So next time someone underestimates long-term care facilities, remind them:

“𝗪𝗲 𝘄𝗲𝗿𝗲 𝗱𝗼𝗶𝗻𝗴 𝗱𝗮𝘁𝗮-𝗱𝗿𝗶𝘃𝗲𝗻 𝗰𝗮𝗿𝗲 𝗯𝗲𝗳𝗼𝗿𝗲 𝗶𝘁 𝘄𝗮𝘀 𝗰𝗼𝗼𝗹.” 😎

#MDSConsultants #LongTermCare #SkilledNursing #MDS #PDPM #QualityCare #NursingHomeHeroes #ClinicalAssessment #DataMatters #FunFactFriday ... See MoreSee Less

Learn how to avoid improper payments. See the SNF Billing Reference educational tool to find out when to bill your patient's prescription drugs to Part A, instead of their Part D drug plan. The Office of the Inspector General found that Medicare Part D improperly paid for drugs during Part A skilled nursing facility (SNF) stays. Drugs prescribed for a Part D-enrolled patient aren’t covered by Part D if Part A or B can pay for them.
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🚨January 1 Revalidation Deadline Indefinitely Suspended-Enrolled skilled nursing facilities (SNFs) should continue collecting data on ownership, managerial, and related party information and submit their revalidation. However, there is no submission deadline until further notice.
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𝗙𝗿𝗶𝗱𝗮𝘆 𝗥𝗲𝗳𝗹𝗲𝗰𝘁𝗶𝗼𝗻

In the world of long-term care, every interview has a person behind it—and we never forget that.

💡 Whether we’re reviewing Section GG or planning an education session, we do it with compassion, clarity, and coffee (lots of coffee).

Happy Friday from the MDS Consultants crew!

Here’s to rest, reflection, and recharging for another week of doing the work that matters.

#LTCVoice #MDSConsultants #FridayThoughts #LTCLeaders #BehindTheMDS ... See MoreSee Less

The November update of Appendix B to the MDS 3.0 RAI User’s Manual contains changes to the list of State RAI Coordinators, MDS Automation Coordinators, and CMS locations and contacts.
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OIG data analysis identified Medicare Part B payments made to optometrists for high-level evaluation and management (E/M) services not usually billed by optometrists. For 2021 through 2023 (audit period), Medicare paid $4.7 million to 200 optometrists for E/M services for moderate to highly complex subsequent nursing facility care. The top 15 optometrists accounted for 72 percent of those payments. This audit examined whether the 15 optometrists complied with Medicare requirements when billing for services at nursing facilities. CMS reimbursed selected optometrists for Part B services that were not billed in accordance with Medicare requirements. All 225 of the enrollees we sampled had associated claim lines of service that did not meet Medicare documentation or coding requirements. OIG recommends that CMS recover the portion of the $3 million in estimated overpayments that are within the 4-year reopening period and develop system edits to prevent the incorrect billing of services.
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Annual therapy code list updates affect therapists (physical therapists, occupational therapists, and speech-language pathologists), physicians, certain non-physician practitioners, and other providers billing Medicare Administrative Contractors (MACs) for therapy services. 𝙈𝙖𝙠𝙚 𝙨𝙪𝙧𝙚 𝙮𝙤𝙪𝙧 𝙗𝙞𝙡𝙡𝙞𝙣𝙜 𝙨𝙩𝙖𝙛𝙛 𝙠𝙣𝙤𝙬𝙨 𝙖𝙗𝙤𝙪𝙩 𝙪𝙥𝙙𝙖𝙩𝙚𝙨 𝙚𝙛𝙛𝙚𝙘𝙩𝙞𝙫𝙚 𝙅𝙖𝙣𝙪𝙖𝙧𝙮 𝟭, 𝟮𝟬𝟮𝟲, 𝙛𝙤𝙧 𝙧𝙚𝙢𝙤𝙩𝙚 𝙩𝙝𝙚𝙧𝙖𝙥𝙚𝙪𝙩𝙞𝙘 𝙢𝙤𝙣𝙞𝙩𝙤𝙧𝙞𝙣𝙜 (𝙍𝙏𝙈) 𝙨𝙚𝙧𝙫𝙞𝙘𝙚𝙨 𝙙𝙚𝙨𝙞𝙜𝙣𝙖𝙩𝙚𝙙 𝙖𝙨 𝙨𝙤𝙢𝙚𝙩𝙞𝙢𝙚𝙨 𝙩𝙝𝙚𝙧𝙖𝙥𝙮:
● New codes
● Revised code descriptors
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𝗞𝗲𝗲𝗽𝗶𝗻𝗴 𝗨𝗽 𝘄𝗶𝘁𝗵 𝗤𝘂𝗮𝗹𝗶𝘁𝘆 𝗠𝗲𝗮𝘀𝘂𝗿𝗲𝘀 𝗶𝗻 𝟮𝟬𝟮𝟲
Our latest newsletter dropped today, and it’s all about staying ahead of Quality Measures as we head into 2026.

𝗛𝗲𝗿𝗲’𝘀 𝗮 𝗾𝘂𝗶𝗰𝗸 𝗿𝗲𝗰𝗮𝗽 𝗼𝗳 𝘄𝗵𝗮𝘁 𝘄𝗲 𝗰𝗼𝘃𝗲𝗿𝗲𝗱:
📌 Falls with Major Injury (FMI) – CMS released the new Technical Specification Report, including methodology and testing results.
📌 MDS 3.0 QM User’s Manual v18.0 – Effective January 1, 2026, with updated QM specs and a Notable Changes section from v17.0.
📌 Five-Star Preview Reports – Available in iQIES starting December 1, 2025, with Nursing Home Care Compare updates on or around December 10.

We also shared our Winter Webinar lineup to help teams translate all of this into real-world planning for 2026.
⭐ Don’t miss our 12/9 webinar as we break down what’s changing and what it means for your QMs, Five-Star, and survey risk going into 2026.
👉 Catch today’s newsletter & register for a webinar: cstu.io/d0d185

#QualityMeasures #MDS30 #SNFQRP #SNFVBP #NursingHomes #LongTermCare #MDSConsultants #Webinar #NurseLeaders #SNFLeadership ... See MoreSee Less