The Minimum Data Set (MDS) is part of the U.S. federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes. This process provides a comprehensive assessment of each resident's functional capabilities and helps nursing home staff identify health problems.

MDS information is transmitted electronically to the MDS database in their respective states. MDS information from the state databases is captured into the national MDS database at Centers for Medicare and Medicaid Services (CMS).

MDS 3.0 has been designed to improve the reliability, accuracy, and usefulness of the MDS, to include the resident in the assessment process, and to use standard protocols used in other settings. These improvements have profound implications for nursing home care and public policy.

Medicare uses a case-mix classification system to assign a nursing home resident to a Resource Utilization Group (RUG) category based on his or her medical conditions and the resources needed to provide care. Each RUG category is tied to a Medicare payment rate.

CMS believes that the currently used RUG-III system is no longer an effective way to determine resource time required to care for certain conditions. A proposed rule released by CMS on May 1st 2009 calls to implement a new case-mix classification model for 2011, known as RUG-IV. Some of the changes incorporated into RUG-IV significantly deviate from the currently used model, RUG-III, and could have a negative impact on reimbursement for Skilled Nursing Facilities.

 

Are you ready for the transition to MDS 3.0 and RUG-IV?

• Do you have updated restorative training available for MDS 3.0?
• Is your rehab team ready to appropriately code for the therapy minutes?
• Is your care planning team ready for new interview processes?
• If you answered 'no' to any of these questions contact GPS!