The SNF (Skilled Nursing Facility) Minimum Data Set (MDS) Assessment is used by the Centers for Medicare and Medicaid Services (CMS) to determine the level of care and reimbursement for SNF residents. Dashes (-) on the MDS Assessment can indicate that a certain item or section was not assessed or not applicable. However, if certain items or sections that are required by CMS are left blank or marked with dashes, it can result in a 2% reduction in reimbursement. This is because the dashes may indicate that the facility is not fully assessing or documenting the resident's condition, which can lead to inaccurate reimbursement and potential quality of care issues.
If a Dash (-) is used in place of a response on a critical item
or if critical items are left incomplete, it may result in the resident being classified at a lower level of care and the SNF receiving less reimbursement. Additionally, if the SNF fails to complete the MDS in a timely manner or does not meet other regulatory requirements, it may also result in payment loss.
Below are a few examples of when using a Dash (-) can result in payment loss for the SNF. However, there can be many other ways that dashes or incompletions on the MDS can result in payment loss for the SNF.
- A resident has a pressure ulcer that needs to be assessed for healing progress. The MDS Assessor is supposed to fill out the appropriate section of the MDS form, indicating the stage of the pressure ulcer and whether it is healing or not. If the MDS assessor uses a dash instead of providing the information, the resident will not be classified as having a pressure ulcer, and the SNF will receive less reimbursement.
- The MDS Assessor fails to document the resident's mobility status, the resident will be classified at a lower level of care, resulting in a lower reimbursement rate for the SNF.
- The facility fails to complete the MDS in a timely manner, it may also result in payment loss. For instance, if the SNF fails to complete the MDS within 14 days of a resident's admission, the SNF may lose the reimbursement for the first 14 days of the resident's stay.
- Dashes (-) on the MDS portrays there is no information available to code the item. Dashes in the below sections are an automatic 2% reduction:
- Dash (-) in the Performance Column of Section GG is a typical issue that interferes with QRP compliance.
- Dash (-) in Section N0450 Anti-Psychotropic Medication review.
- Dash (-) in Section N2001 Drug Regimen Review.
- Dash (-) in Section N2003 Medication Follow up of Drug Regimen Review.
- Dash (-) in Section O0250 Influenza Vaccination.
- Dash (-) in Section O0300 Pneumococcal Vaccination.
Excessive use of Dashes (-) in any assessment item affects the accuracy of the quality measures reported on Nursing Home Compare and the 5-Star Nursing Home Quality Rating System.
Using a Dash (-) may reduce the size of the facility’s quality measure resident sample and result in an inaccurate representation of the facility’s actual resident population. Important clinical information regarding resident condition may be missing, and missing data will also skew the quality measures. This will impede facilities’ ability to be able to demonstrate quality improvement and to accurately determine appropriate care for its residents.
Several Quality Measures use data from the sections of the MDS 3.0 that assess:
- Mental Status,
- Depression, and
- Pain.
Under certain circumstances, these measures also use data from the MDS Discharge Assessment.
In all cases, these measures will use data from the resident interviews, when and if the interview sections are complete.
- If the resident interviews are not complete, the measures will use data from the staff assessments.
- If neither the resident interview nor the staff assessment is available for one of these three sections (because of the use of dashes), the resident may be excluded from the quality measure calculation, thereby reducing the facility’s sample size when calculating the measure and compromising the accuracy of the quality measure.
Therefore, it is important for providers to:
- Educate Staff not to use dashes on all MDS Assessments, (including Discharge Assessments).
- Educate Staff to complete the resident interviews, and
- Educate Staff to complete the staff interviews (if the resident interview is not feasible).
This will ensure that the sample used for the facility’s quality measures is as representative as possible.
In summary, accurate MDS Coding yields precise reimbursement and enhances the quality of care rendered to the SNF’s patient population.
