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10 ways to Increase your Case Mix Index


There are numerous ways a facility can increase their Case Mix Index.  Facilities must monitor the follow criteria to ensure proper Medicaid Reimbursement and increase your Case Mix Index.

  1. Emergency Room Visits: IV medications, IV fluids, oxygen and blood transfusions may have been administered to patients while in the Emergency Room.
  2. Hospital Stays of Less Than Three Days: IV fluids, IV medications, surgical wounds, blood transfusions, IV contrast material for testing purposes may have been administered while in the hospital.
  3. Flu Symptoms: Patients frequently require additional physician visits, may have additional physician orders, may have a fever and vomiting and may require oxygen. Patients will often have a diagnosis of pneumonia with fever or weight loss with a fever during these illnesses.
  4. Podiatry Visits: Foot lesions are defined as any cuts, ulcers or fissures. These may occur after being seen by the podiatrist or may be the reason for a podiatry visit. Remember that ankle problems are not considered foot problems and should not be coded in this section.
  5. Skin Issues: Any skin issues that occur should be followed by a chart audit by the MDS Coordinator to determine if these skin issues are as a result of pressure, venous stasis or excoriations due to incontinence. Early identification and coding of skin issues on the MDS assures that these issues are being care planned and treated.
  6. Rehabilitation: The Rehabilitation department should alert the MDS Coordinator whenever a patient is placed on their case load for Medicare Part B services. The MDS Coordinator in collaboration with the rehab staff can determine if an early MDS Assessment is warranted to capture the rehab services to increase the case mix.
  7. Tracking of Physician Visits: It is beneficial an easier to track physician visits in comparison to days of physician order changes. When a patient has had two physician visits in a 14 day window, the MDS coordinator can then review the chart to determine if there have been two days of order changes in order to capture a Clinically Complex category.
  8. Review of Daily Census: This will alert the MDS Coordinator regarding hospitalizations and ER visits.
  9. Review of Daily Shift Communications: Reviewing the communication between shifts may alert the MDS Coordinator to symptoms of flu, pneumonia, fevers, vomiting, oxygen use or other medical conditions that may require additional nursing services.
  10. Respiratory Therapy:  Patients who have orders for nebulizer treatments should become a focus for review to determine if they will have 7 days of respiratory therapy services which may include breathing exercises, evaluation of lung sounds, oxygen saturation in addition to the nebulizer treatments.


PEPPER Analysis




great info
Posted @ Monday, August 19, 2013 3:05 AM by Yasser Nakhlawi Nakhlawi
Thank you Mr. Nakhlawi. We appreciate the feedback. Please let us know additional topics you are interested in reading about.  
Elisa Bovee 
VP of Operations
Posted @ Monday, August 19, 2013 6:01 AM by Elisa Bovee
Love the way this information is in laid out. I am giving this to our IDC team, so everyone will be focused on what we need. 
Thank you!!!!
Posted @ Saturday, November 09, 2013 6:04 PM by Christina Mazmanian
Christina, Thank you for the feedback! Please contact us with any additional questions you may have regarding Case Mix or Medicare Regulations and reimbursement. Sincerely, Elisa Bovee
Posted @ Sunday, November 10, 2013 7:16 AM by Elisa Bovee
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