CMS & OIG

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Nov 01 2026
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MDS Changes Effective Oct 1, 2026

This year Centers for Medicare and Medicaid (CMS) did not add any Minimum Data Set (MDS) data element items, but a few coding instructions were changed. These are small but important changes that can have a significant impact on data integrity and accurate MDS coding, care planning, reimbursement, and quality measures. This blog will review   interview updates in Sections A, C, and D, clarification to capture shortness of breath in Section J, clarifications for coding related to pressure...
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Oct 01 2026
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MDS Under Review: Building an Accurate, Reproducible, and Audit-Ready Assessment

History of MDS 3.0 Audits The Centers for Medicare and Medicaid (CMS) audits of skilled nursing facility (SNF) Minimum Data Set (MDS) data are nothing new. The MDS is a Resident Assessment Instrument (RAI) that CMS has created and mandated to provide each resident with a standardized, comprehensive and reproducible assessment. This tool assesses a resident’s ability to perform daily life functions, identifies significant impairments in a resident’s functional capacity, and provides...
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Mar 01 2026
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From Orders to Action: Aligning Care Plans and Psychotropic Medications

Critical Element Pathways (CEPs) are tools in the Long-Term Care State Operations Manual (SOM) that are developed by Centers for Medicare and Medicaid (CMS) and utilized by surveyors along with interpretive guidance to evaluate each facility’s adherence to specific Federal Tag (F-tag) requirements. To evaluate resident care, each CEP is formatted to explain the purpose of investigation, with directions about which records to review – including Minimum Data Set (MDS) and care plans. Each CEP...
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Jan 01 2026
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From Coding to Compliance: Avoiding Pitfalls in the 2026 MDS Landscape

With the numerous regulatory bodies that govern long term care (LTC) and skilled nursing facilities (SNF), it is easy to feel like there is no end to the Resident Assessment Instrument (RAI) and Minimum Data Set (MDS) “rules.” There are Federal, State, and sometimes local regulations. There are facility policies that may be in place (in response to a survey deficiency, as an extension of a corporate requirements, or simply “because we have always done it this way”). There is the internet and...
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Dec 01 2025
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Keeping Up with Quality Measures in 2026

Quality measures (QM) that are driven by MDS data are currently utilized for long term care (LTC) facilities and skilled nursing facilities (SNF) in several ways. These QMs are publicly reported via the Care Compare (CC) website and accompanying Five Star Ratings. MDS-driven QMs also play a significant role in the Annual Payment Update (APU) for the Skilled Nursing Facility Quality Reporting Program (SNF QRP) – and will be playing a larger role in the Skilled Nursing Facility Value Based...
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Nov 01 2025
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The Latest in the Lineup: The Skilled Nursing Facility Validation Program

The Centers for Medicare and Medicaid (CMS) audits of skilled nursing facility (SNF) Minimum Data Set (MDS) data are nothing new. The MDS 3.0 was implemented in 2010, and in 2014 CMS piloted MDS Focused Surveys in 5 states. The results of the pilot study prompted full implementation of MDS Focused Surveys nationwide, and these surveys continued through Fiscal Year (FY) 2017. Since then, CMS has instituted a different approach to reviewing MDS accuracy, and SNFs are now subject to a variety of...
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Oct 01 2025
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How the MDS is Utilized During the Survey Process

Have you ever wondered how the survey team determines which residents they will focus on during a standard survey in the skilled nursing facility/long term care facility (SNF/LTC)? The answers submitted to the Center for Medicare and Medicaid (CMS) on the Minimum Data Set (MDS) are a starting point for the survey process.   MDS USAGE The MDS is a versatile tool utilized as the beginning of individual resident care planning, contributing to a comprehensive facility assessment, driving...
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Sep 01 2025
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Fall MDS Updates are Here!

October 1 is typically when the Centers for Medicare and Medicaid Services (CMS) institutes changes to the Resident Assessment Instrument (RAI) and Minimum Data Set (MDS) – and this year is no exception. CMS has rescinded a few things that were anticipated and added a few things that may be a surprise. Post-acute care providers will want to make sure that staff are aware of the updates and have processes in place to ensure a smooth transition from September into October.   What Has CMS...
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Jul 01 2025
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The Facility Assessment and Emergency Management Planning: The MDS Plays a Big Role

  What is the MDS Role in the Facility Assessment? F838 in the State Operations Manual (SOM) provides specific information for developing a Facility Assessment that must be reviewed and updated at least annually. A well-developed facility assessment is a template that guides staff in determining what resources are necessary to care for residents competently during both day-to-day operations and in emergencies. Accurate data collected and recorded on the MDS can be used to generate helpful...
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Apr 01 2025
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MDS Errors: Steps for Correction

What does the NAC do when they identify an error on an MDS assessment? The answer is correct the identified error. Any error that incorrectly represents the resident's status needs to be corrected. One would think correcting an MDS error would be a “simple” process, but MDS corrections can be a multifaceted undertaking. When an MDS error is identified, the NAC must determine what type of error has occurred and if the MDS assessment has been submitted to iQIES (Internet Quality Improvement and...
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Mar 01 2025
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RAI and MDS Compliance: The Importance of the Administrator in the Lineup

With the Minimum Data Set (MDS), the Centers for Medicare and Medicaid (CMS) created a standardized, reliable, reproducible framework for assessing long term care resident status. As a result, MDS data plays a significant role in myriad areas of skilled nursing – from resident care plans to quality measures and reimbursement – which are governed through regulatory compliance. While adherence to these guidelines certainly falls to MDS Coordinators and Interdisciplinary Team (IDT) members, there...
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Aug 01 2024
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Internet Quality Improvement and Evaluation System (iQIES): A New Age

Just when we thought we had a handle on QIES (Quality Improvement and Evaluation System), the Centers for Medicare & Medicaid Services (CMS) transitioned to the Internet Quality Improvement and Evaluation System (iQIES) in 2023.   Reports and Roles Reports generated from MDS submissions (along with other reports) are available in the iQIES portal. Becoming familiar with what reports are available, who in the organization is responsible for “pulling” the reports, how often to pull the...
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Nov 04 2022
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Pillars of Care

Reviewing the Behavioral Health Pillars The US Department of Health and Human Services (HHS) developed a roadmap for behavioral health integration to address a national mental health crisis.  The current Administration's strategy is based on three core pillars: 1. Strengthen System Capacity 2. Connect Americans to Care3. Support Americans by Creating Healthy Environments While the HHS Roadmap does not specifically address Skilled Nursing Facilities, it requires efforts throughout the...
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Oct 07 2022
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MDS surprises fill new draft

Joe Bush | Oct 7, 2022 | Excerpted from McKnights Long-term care facilities, staff and more than half the states should prepare immediately for changes to the Minimum Data Set, experts said in early September. The Centers for Medicare & Medicaid Services released a draft of an update to MDS 3.0. Section G, used by many states to determine Medicaid reimbursement, is gone. The changes will be official in October 2023. Gloria Brent, president and CEO of MDS Consultants, told McKnight’s it was...
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Sep 07 2022
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MDS draft sends sector, states scrambling to assess effects

Joe Bush | Sept 7, 2022 | McKnights Long-term care facilities, staff and more than half the states in the US should start preparing immediately for extensive changes to the Minimum Data Set, resident assessment experts said this week. The Centers for Medicare & Medicaid Services last week released a draft of long-awaited update to MDS 3.0. Section G, used by many states to determine Medicaid reimbursement, is gone. Added were additional intake questions and a need for more robust...
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Jun 17 2022
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What’s New from CMS?

WHAT’S NEW FROM CMS? As the world tries to find a new normal, long-term care (LTC) professionals are watching what changes will come down from various White House initiatives. These initiatives to improve nursing homes include: CMS modifications for reimbursement and Continued changes related to COVID-19 reporting and care in the facilities. LTC professionals seeking to improve care, deal with staff crisis, and simple ways to implement required changes heard a recent talk by Ellen M. Berry, PT...
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Mar 03 2022
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Are You Paying Attention to Resident Discharge?

Are you Paying Attention to Resident Discharge? CMS & OIG Are In 2017, CMS put into effect the final rule that focused on discharge planning for residents from the nursing home setting. From monitoring deficiencies data, we know some facilities still do not follow current guidelines. What has become important when it comes to discharges? Discharge Planning Starts at Admission The discharge planning process is initiated on admission to the nursing home and requires a team effort involving...
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Feb 03 2022

OIG Report Cites Challenges

Top SNF Challenges from the OIG Report OIG released a report of the 2021 Top Management and Performance Challenges Facing the Department of Health and Human Services (HHS). The report from the Office of Inspector General (OIG) is titled, “2021 Top Management and Performance Challenges Facing HHS.”  It is worth a closer look at how this information will influence nursing home care.  This report keeps us informed on what federal organizations look at as they make future regulations for SNF's....
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Sep 06 2021
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Prepare Your Team for FY2022

The Updated SNF PPS Final Rule Skilled nursing facilities should be preparing now for these upcoming changes. This On August 4th CMS rule refresh: Updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for the fiscal year 2022 Updates the diagnosis code mappings used under the Patient-Driven Payment Model (PDPM) Implements a recently-enacted SNF consolidated billing exclusion, and Includes a discussion of a PDPM parity adjustment that...
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Aug 02 2021
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ICD-10 Coding and Guideline Updates for FY 2022

ICD-10 Updates Earlier this summer, the Centers for Medicare & Medicaid Services (CMS) released the ICD-10-CM code descriptions, tables and index, and addendum for the fiscal year 2022. Then on July 12th, the Official Guidelines for Coding and Reporting of ICD-10-CM became available online. The updated manual and guidelines for FY 2022 revealed 159 new codes, along with the Tabular and Index Addenda. Below is a summary of the changes that will most affect the Skilled Nursing Facilities...
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Recent Blogs in All Topics

Nov 01 2026
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MDS Changes Effective Oct 1, 2026

This year Centers for Medicare and Medicaid (CMS) did not add any Minimum Data Set (MDS) data element items, but a few coding instructions were changed. These are small but important changes that can have a significant impact on data integrity and...
Keep Reading
Oct 01 2026
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MDS Under Review: Building an Accurate, Reproducible, and Audit-Ready Assessment

History of MDS 3.0 Audits The Centers for Medicare and Medicaid (CMS) audits of skilled nursing facility (SNF) Minimum Data Set (MDS) data are nothing new. The MDS is a Resident Assessment Instrument (RAI) that CMS has created and mandated to...
Keep Reading
Sep 01 2026
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From Lag Time to Real Time: SNF QRP and SNF VBP Submission Deadline Updates

The 2027 SNF PPS Final Rule finalized CMS’s proposal to revise the submission deadlines for both the SNF QRP and SNF VBP programs. The change applies to MDS assessment data and CDC NHSN data items.   The SNF QRP and SNF VBP publicly reported data...
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Aug 01 2026
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Beyond the Dashboard: Using iQIES to Drive Quality and Compliance in SNFs

The Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program is a Centers for Medicare & Medicaid Services (CMS) program that awards incentive payments to skilled nursing facilities (SNFs) to encourage SNFs to improve the quality of...
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Jul 01 2026
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From Quality to Financial Performance: How QMs Influence SNF VBP and Five-Star Ratings

Overview of The SNF VBP Program  The Skilled Nursing Facility Value-Based Purchasing program (SNF VBP) is a Medicare pay-for-performance program that is intended to encourage SNFs to improve the quality of care they provide to their residents. All...
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Jun 07 2026
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What Really Counts: How Quality Measures Shape Compliance, Reporting, and Performance

If your Facility-level and Resident-level MDS 3.0 Quality Measures (MDS 3.0 QM), the Skilled Nursing Facility MDS 3.0 Quality Reporting Program Quality Measures (MDS 3.0 SNF QRP QM), or Five Star QM reporting on Care Compare are missing the mark...
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May 01 2026
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Beyond the Scorecard: Turning Quality Measure Data into Action

Data coded on the Minimum Data Set (MDS) is collected during structured and defined time periods; what happens with the resident outside of those time periods cannot be captured on the MDS and will not impact your quality measures (QMs) apart from...
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Apr 01 2026

Care Planning to Reduce the Risk for Chemical Restraint

How can we turn care plans from an exercise in paper compliance that few staff understand, let alone review or utilize, to a workable document that helps us manage resident needs? When thinking about how to create an effective care plan for an “as...
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Mar 01 2026
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From Orders to Action: Aligning Care Plans and Psychotropic Medications

Critical Element Pathways (CEPs) are tools in the Long-Term Care State Operations Manual (SOM) that are developed by Centers for Medicare and Medicaid (CMS) and utilized by surveyors along with interpretive guidance to evaluate each facility’s...
Keep Reading
Feb 01 2026

F641 in Plain English – How Interview Accuracy Protects Your CMI

When surveyors look at MDS accuracy, they’re not just checking boxes – they’re looking at whether the assessment truly reflects the resident. F641 holds the interdisciplinary team and nursing leadership accountable for how the assessment is...
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Jan 01 2026
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From Coding to Compliance: Avoiding Pitfalls in the 2026 MDS Landscape

With the numerous regulatory bodies that govern long term care (LTC) and skilled nursing facilities (SNF), it is easy to feel like there is no end to the Resident Assessment Instrument (RAI) and Minimum Data Set (MDS) “rules.” There are Federal,...
Keep Reading
Dec 01 2025
,

Keeping Up with Quality Measures in 2026

Quality measures (QM) that are driven by MDS data are currently utilized for long term care (LTC) facilities and skilled nursing facilities (SNF) in several ways. These QMs are publicly reported via the Care Compare (CC) website and accompanying...
Keep Reading
Nov 01 2025
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The Latest in the Lineup: The Skilled Nursing Facility Validation Program

The Centers for Medicare and Medicaid (CMS) audits of skilled nursing facility (SNF) Minimum Data Set (MDS) data are nothing new. The MDS 3.0 was implemented in 2010, and in 2014 CMS piloted MDS Focused Surveys in 5 states. The results of the pilot...
Keep Reading
Oct 01 2025
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How the MDS is Utilized During the Survey Process

Have you ever wondered how the survey team determines which residents they will focus on during a standard survey in the skilled nursing facility/long term care facility (SNF/LTC)? The answers submitted to the Center for Medicare and Medicaid (CMS)...
Keep Reading
Sep 01 2025
,

Fall MDS Updates are Here!

October 1 is typically when the Centers for Medicare and Medicaid Services (CMS) institutes changes to the Resident Assessment Instrument (RAI) and Minimum Data Set (MDS) – and this year is no exception. CMS has rescinded a few things that were...
Keep Reading
Aug 01 2025
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Medicaid PDPM Is Coming: What Skilled Nursing Facilities Need to Know

Beginning October 1, 2025, many nursing homes will adopt a new reimbursement model for Medicaid residents: the Patient-Driven Payment Model, or Medicaid PDPM. While PDPM has been in place for Medicare since 2019, this is the first time it’s being...
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Jul 01 2025
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The Facility Assessment and Emergency Management Planning: The MDS Plays a Big Role

  What is the MDS Role in the Facility Assessment? F838 in the State Operations Manual (SOM) provides specific information for developing a Facility Assessment that must be reviewed and updated at least annually. A well-developed facility...
Keep Reading
Jun 01 2025
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MDS Nutrition – Not Limited to Section K

Often Section K on the MDS, associated CAAs, and care planning are relegated to the dietician to worry about. However, when we look at a comprehensive MDS, we can see that the information in Section K is only part of the resident's nutritional...
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May 01 2025
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Celebrating Skilled Nursing

National Skilled Nursing Week is held annually in May to recognize long-term care professionals that care for our residents in Skilled Nursing Facilities. This year’s National Skilled Nursing Week is May 11 - 17 and the theme is “Tapestry of Life”...
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Apr 01 2025
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MDS Errors: Steps for Correction

What does the NAC do when they identify an error on an MDS assessment? The answer is correct the identified error. Any error that incorrectly represents the resident's status needs to be corrected. One would think correcting an MDS error would be a...
Keep Reading
Mar 01 2025
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RAI and MDS Compliance: The Importance of the Administrator in the Lineup

With the Minimum Data Set (MDS), the Centers for Medicare and Medicaid (CMS) created a standardized, reliable, reproducible framework for assessing long term care resident status. As a result, MDS data plays a significant role in myriad areas of...
Keep Reading
Feb 01 2025

Laying the Foundation – Care Area Assessments to Care Plans

Because Care Area Assessments (CAAs) are not submitted to CMS, and the Resident Assessment Instrument (RAI) manual offers little guidance on how to complete a CAA when compared to the Minimum Data Set (MDS) instructions, CAAs are a segment of the...
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Jan 01 2025

Navigating the 2025 Winds of Change: New Survey Guidance

The 2025 new year has begun with a whirlwind of changes in Long-Term Care – starting with New Surveyor Guidance. CMS released an advanced copy of these State Operations Manual Appendix PP (Guidance for Skilled Nursing Facilities) updates in a...
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Dec 01 2024
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What is an MDS Coordinator?

"What do you do for a living?" It may not surprise you that when asked this question, most MDS Coordinators struggle to come up with an answer. The reality is that MDS Coordinators fully understand what this multifaceted job entails, but are at a...
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Nov 01 2024
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From the MDS to RAI System Management

With the introduction of the Minimum Data Set (MDS) through the Omnibus Budget Reconciliation Act (OBRA) of 1987, Centers for Medicare and Medicaid (CMS) implemented a method of standardized, comprehensive, and reproducible data collection for long...
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Oct 01 2024

Maximizing Case Mix with Special Programs: Respiratory Therapy and Restorative Nursing

Case mix is essential in skilled nursing facilities as it impacts both reimbursement and the care provided. Two key programs that significantly impact case mix scores when properly implemented and documented are Respiratory Therapy and Restorative...
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Sep 01 2024

Strategic Admissions: The Path to Optimized Medicaid Reimbursement

Medicaid reimbursement plays a significant role in the financial health of long-term care facilities, particularly those serving a high percentage of Medicaid residents. While it may not be the sole source of revenue, it is an important component...
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Aug 01 2024
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Internet Quality Improvement and Evaluation System (iQIES): A New Age

Just when we thought we had a handle on QIES (Quality Improvement and Evaluation System), the Centers for Medicare & Medicaid Services (CMS) transitioned to the Internet Quality Improvement and Evaluation System (iQIES) in 2023.   Reports...
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Jul 01 2024
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A Significant Change in Status Assessment – There are Options

The Resident Assessment Instrument (RAI) system includes a significant change in status assessment (SCSA). What might be forgotten is the State Operation Manual (SOM), Appendix PP, includes information that mirrors the RAI manual at 42 CFR...
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Jun 01 2024
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Interim Payment Assessment (IPA) – To do or not to do?

The Patient-Driven Payment Model took effect in October of 2019. Along with this change came the optional IPA. We are now five years into this change and questions still arise on when to complete an IPA. The decision of when to complete lies with...
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