Medicaid: Case Mix

In most states, the MDS is also the foundation of the Medicaid reimbursement methodology.

It is used to classify residents into resource utilization groups (RUGs) that in turn generates a Case Mix score contributing to adjustments to the facility's Medicaid Rate. As with Medicare reimbursement, the MDS contains extensive information on the resident’s nursing needs, ADL impairments, cognitive status, behavioral problems, and medical diagnoses. Harmony Healthcare International (HHI) is available to assist the provider in understanding state specific regulations for compliant scheduling and completion of the MDS to ensure the accurate reflection of the clinical conditions and services rendered to the long term care population of the SNF.

How can Harmony Healthcare International (HHI) help?

Harmony Healthcare International (HHI) Case Mix services include: 

  • Review of current Medicaid Case Mix Process
  • Review of state specific Medicaid Case Mix reimbursement system and classification
  • Compliance audits for MDS Accuracy, MDS supporting documentation, therapy documentation, nursing documentation, physician certification completion, medical necessity and other needed elements to support claim integrity
  • Medicare Part B Therapy Utilization Review (PT, OT and ST)
  • ADL Coding: Supporting Documentation and MDS Accuracy
  • Case Mix Documentation Review
  • State Case Mix specific education
  • Medicare Part B Therapy Documentation Review
  • Nursing Documentation Review
  • Comprehensive Written Report
Request a Consultation