Case Mix Assessment Reference Date Management: Increased communication among the nursing staff has the potential to positively impact the case mix index. The MDS coordinator should ask Unit Managers about ER visits, oxygen use, skin assessments, flu symptoms, respiratory infections or symptoms, weight loss, foot wounds, and transfusions on a regular basis. These situations often increase physician visits and days of physician order changes or may qualify for a higher category themselves.
Repetitive questions regarding these issues will highlight the benefit of communication of these additional services and changes in patients' status. This will afford the MDS Coordinator an opportunity to review the patient's clinical record and change the Case Mix Assessment Reference Date if needed.
Assessment Reference Dates in many cases cannot be extended due to the regulatory limitations. Assessment Reference Dates can, however, be moved earlier to capture Physician's visits and days of Physician's order changes, skin issues, higher ADL needs and other services required by the patient such as oxygen use. Additional quarterly assessments may also be completed to capture this increased delivery of services to patients and the appropriate reimbursement for the additional staff time and resources of the facility.