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Increasing your Medicaid Case Mix Index

  
  
  

Increase your Medicaid CASE MIX INDEX

Medicaid Case Mix:  Are you in a case mix state yet?  If no, you soon will be too.  Thirty plus states have converted from their standard Medicaid reimbursement system to a MDS/RUG's based system.  Currently, New York and Texas are the latest to initiate conversion from PRI's and TILES, respectively.  Each state creates specific criteria for reimbursement, however, there are certain elements that remain constant.  Harmony, through on-site auditing and education, significantly impacts the facility's Medicaid rate.  In the month's preceding rate setting, chart audit of the facility Medicaid census is imperative to ensure optimal and accurate reimbursement.  New Hampshire will begin their 3 month window of auditing next month.  In the coming weeks, Harmony will provide case mix tips.

Tip #1

Rehabilitation:  During the case mix snapshot, therapy involvement may yield a higher CMI (Case Mix Index).

Too often, the therapists are unaware of the criteria and provide services only 3x/week.  This frequency does not yield a case mix level (unless accompanied by 6 days of restorative nursing).  Therefore, the only way for therapy intensity to impact financially is for the frequency to be at 5x/week.

Clinically, this duration can be justifiable, however, realize that the 5x/week intensity impacts the spell of illness.

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