News for MDS Experts

🚨 Do you know what reports to view in iQIES for your facility? The CMS iQIES Reports User Manual V2.10 was posted 9/26/2025. SNF's can utilize the MDS 3.0 Reports, PBJ Reports, and S&C Reports.
cstu.io/ea214c
Located under iQIES Reports Training Materials
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Errata V3.10.3 is now available for the MDS Data Specifications V3.10.2 (FINAL) under the Downloads section at the bottom of this webpage. Three issues have been identified, two of which will result in the addition of edits -4097 and -4098 to replace deleted edits -3852 and -3994, respectively. The other issue corrects a typo in the allowed values for a Section S item. These revisions will go into production on October 1, 2025.
cstu.io/571cb4
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CMS Transmittal 13426: SNF Consolidated Billing HCPCS 2026 Update. Effective date: January 1, 2026, and Implementation date: January 5, 2026.
The purpose of this Change Request (CR) is to identify the changes to HCPCS codes and explain how Medicare Physician Fee Schedule designations will be used to revise Common Working File (CWF) edits to allow A/B Medicare Administrative Contractors (MACs) to make appropriate payments in accordance with policy for SNF CB in Chapter 6, Section 110.4.1 for A/B MACs (B) and Chapter 6, Section 20.6 for A/B MACs (A).
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📢The posted final Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) User’s Manual version (v)1.20.1 has been updated to align with the revisions to item J1900 in the release of the MDS item sets v1.20.1v4. Minor corrections have also been implemented to the MDS RAI User's Manual since the prior release on 8/29/2025. All changes to the posted version of the final MDS 3.0 RAI User’s Manual v1.20.1 are identified in included chapter/section change tables and noted in the list, below:
𝗣𝗴. 𝟯-𝟰: 𝗨𝗽𝗱𝗮𝘁𝗲𝗱 𝗿𝗲𝗳𝗲𝗿𝗲𝗻𝗰𝗲 𝘁𝗼 𝗿𝗲𝗺𝗼𝘃𝗲𝗱 𝘀𝘂𝗯-𝗶𝘁𝗲𝗺𝘀 𝗼𝗳 𝗶𝘁𝗲𝗺 𝗢𝟬𝟰𝟬𝟬.
𝗣𝗴. 𝗝-𝟯𝟳: 𝗨𝗽𝗱𝗮𝘁𝗲𝗱 𝘀𝗰𝗿𝗲𝗲𝗻𝘀𝗵𝗼𝘁 𝗳𝗼𝗿 𝗶𝘁𝗲𝗺 𝗝𝟭𝟵𝟬𝟬.𝗣𝗴.
𝗫-𝟵: 𝗨𝗽𝗱𝗮𝘁𝗲𝗱 𝗿𝗲𝗳𝗲𝗿𝗲𝗻𝗰𝗲 𝘁𝗼 𝗿𝗲𝗺𝗼𝘃𝗲𝗱 𝘀𝘂𝗯-𝗶𝘁𝗲𝗺 𝗼𝗳 𝗶𝘁𝗲𝗺 𝗢𝟬𝟰𝟬𝟬.
Please replace any previously downloaded versions of the Final MDS 3.0 RAI User’s Manual v1.20.1 with the version posted on September 24, 2025.
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𝗜𝗖𝗬𝗠𝗜: What OIG Found; Nursing homes failed to report 43 percent of falls with major injury and hospitalization among Medicare-enrolled residents, as required, in resident assessments.
For-profit and chain nursing homes as well as larger nursing homes failed to report falls most often.
Fall reporting varied widely by State and was worse among nonrural nursing homes.
Nursing homes failed to report falls more often for younger residents, male residents, short-stay residents, and residents with only Medicare coverage.
𝗡𝘂𝗿𝘀𝗶𝗻𝗴 𝗵𝗼𝗺𝗲𝘀’ 𝗳𝗮𝗶𝗹𝘂𝗿𝗲 𝘁𝗼 𝗿𝗲𝗽𝗼𝗿𝘁 𝗳𝗮𝗹𝗹𝘀 𝗼𝗻 𝗠𝗗𝗦 𝗮𝘀𝘀𝗲𝘀𝘀𝗺𝗲𝗻𝘁𝘀 𝗹𝗲𝗮𝗱𝘀 𝘁𝗼 𝗶𝗻𝗮𝗰𝗰𝘂𝗿𝗮𝘁𝗲 𝗳𝗮𝗹𝗹 𝗿𝗮𝘁𝗲𝘀 𝗼𝗻 𝗖𝗮𝗿𝗲 𝗖𝗼𝗺𝗽𝗮𝗿𝗲.
OIG Recommended-𝗖𝗠𝗦 𝘀𝗵𝗼𝘂𝗹𝗱 𝘁𝗮𝗸𝗲 𝘀𝘁𝗲𝗽𝘀 𝘁𝗼 𝗲𝗻𝘀𝘂𝗿𝗲 𝘁𝗵𝗲 𝗰𝗼𝗺𝗽𝗹𝗲𝘁𝗲𝗻𝗲𝘀𝘀 𝗮𝗻𝗱 𝗮𝗰𝗰𝘂𝗿𝗮𝗰𝘆 𝗼𝗳 𝘁𝗵𝗲 𝗻𝘂𝗿𝘀𝗶𝗻𝗴 𝗵𝗼𝗺𝗲-𝗿𝗲𝗽𝗼𝗿𝘁𝗲𝗱 𝗠𝗗𝗦 𝗱𝗮𝘁𝗮 𝘂𝘀𝗲𝗱 𝘁𝗼 𝗰𝗮𝗹𝗰𝘂𝗹𝗮𝘁𝗲 𝘁𝗵𝗲 𝗾𝘂𝗮𝗹𝗶𝘁𝘆 𝗺𝗲𝗮𝘀𝘂𝗿𝗲𝘀 𝗳𝗼𝗿 𝗳𝗮𝗹𝗹𝘀 𝘄𝗶𝘁𝗵 𝗺𝗮𝗷𝗼𝗿 𝗶𝗻𝗷𝘂𝗿𝘆.𝗖𝗠𝗦 𝘀𝗵𝗼𝘂𝗹𝗱 𝗲𝘅𝗽𝗹𝗼𝗿𝗲 𝘄𝗵𝗲𝘁𝗵𝗲𝗿 𝗮𝗽𝗽𝗿𝗼𝗮𝗰𝗵𝗲𝘀 𝘁𝗼 𝗶𝗺𝗽𝗿𝗼𝘃𝗲 𝘁𝗵𝗲 𝗾𝘂𝗮𝗹𝗶𝘁𝘆 𝗺𝗲𝗮𝘀𝘂𝗿𝗲𝘀 𝗿𝗲𝗹𝗮𝘁𝗲𝗱 𝘁𝗼 𝗳𝗮𝗹𝗹𝘀 𝗰𝗼𝘂𝗹𝗱 𝘀𝗶𝗺𝗶𝗹𝗮𝗿𝗹𝘆 𝗯𝗲 𝘂𝘀𝗲𝗱 𝘁𝗼 𝗶𝗺𝗽𝗿𝗼𝘃𝗲 𝘁𝗵𝗲 𝗮𝗰𝗰𝘂𝗿𝗮𝗰𝘆 𝗼𝗳 𝗼𝘁𝗵𝗲𝗿 𝗻𝘂𝗿𝘀𝗶𝗻𝗴 𝗵𝗼𝗺𝗲 𝗾𝘂𝗮𝗹𝗶𝘁𝘆 𝗺𝗲𝗮𝘀𝘂𝗿𝗲𝘀.
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𝗧𝗼𝗺𝗼𝗿𝗿𝗼𝘄, 𝗢𝗰𝘁𝗼𝗯𝗲𝗿 𝟭: CMS’s MDS 3.0 RAI User’s Manual v1.20.1 and MDS Item Sets v1.20.1 go live.

𝗤𝘂𝗶𝗰𝗸 𝗵𝗶𝘁𝘀 𝗳𝗼𝗿 𝘆𝗼𝘂𝗿 𝗠𝗗𝗦/𝗥𝗔𝗜 𝘁𝗲𝗮𝗺 𝘁𝗼 𝗿𝗲𝘃𝗶𝗲𝘄 𝗯𝗲𝗳𝗼𝗿𝗲 𝗺𝗼𝗿𝗻𝗶𝗻𝗴 𝗵𝘂𝗱𝗱𝗹𝗲:

• A0810 (“Sex”) replaces A0800 (“Gender”); align your templates/workflows.
• J1900 (falls) language refined, double-check coding guidance and examples.
• Section R not implemented.

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