MDS Consulting for Nursing Homes: A Brief Guide

We should start by saying that MDS or Minimum Data Set is the federally mandated process in the US for clinical assessment of all people in Medicaid and Medicare licensed nursing homes.

You can also use it for non-critical access hospitals that feature bad agreements with Medicare, where bad refers to rural and small hospitals that are part of SNF or skilled nursing facilities.

Therefore, the process will offer you a thorough assessment of the functional capabilities of each resident, which allows a nursing home to identify specific health issues everyone is facing.

The essential aspect of this process is RUG or Resource Utilization Group. If you wish to learn more about MDS in nursing homes, we recommend you enter a link we shared with you.

You should remember that Resource Utilization Groups will provide you with the foundation in which you can formulate individual care plans for residents. Generally, you can complete the MDS assessment forms for all residents within the certified nursing homes without thinking about the payment.

Remember that MDS assessments are essential for residents on admission to the nursing facility. It should happen at specific times and follow relevant guidelines.

Participants include direct staff and health care professionals such as Licensed Nurses, Registered Nurses, Social Services, Therapists, Dietary staff, and other people who work in nursing homes. You can transmit the data electronically by using a specifically created database that operates within the state you are in.

Everything You Should Know About Resource Utilization Groups

RUG or Resource Utilization Groups include a system for grouping nursing home residents based on the functional and clinical status that is part of MDS. Generally, the US Department of Health and Human Services are publishing everything, while the RUG is a classification system used to determine the levels of reimbursement for licensed facilities.

They will determine the payment based on classifying residents based on their resource requirements and overall care. The CMS or Centers for Medicare and Medicaid Service states that the MDS is a mandated process, meaning you should implement a comprehensive assessment of overall abilities and identify potential health issues too.

Assessment happens when you admit the resident at a long-term facility, while you should repeat the process during the stay and before discharge.

However, after the autumn of 2019, Patient-Driven Payment Model (PDPM) replaced Resource Utilization Groups, which is important to remember. We recommend you to click here to learn everything about the Minimum Data Set.

Why Did PDPM Replace RUG?

Although the resource utilization group system had transparent and effective options for nursing facilities to implement relevant info, you should know that it features a wide array of issues as well.

For instance, when using RUG, long-term care facilities would get reimbursement for therapy services, however, other services would not receive relevant amounts based on the regulations. At the same time, it was not a holistic payment system.

As mentioned above, therapy sessions entered the point of reimbursement, while other options were not. Therefore, when a nursing home takes residents on an excursion to boost their enjoyment and lifestyle, the RUG would not offer reimbursement for the process.

Generally, facilities would compete for specific cases, which created a toxic environment. When using RUG, nursing homes would compete for less complicated referrals and cases. That resulted in hospitals being unable to refer patients with complicated medical issues to nursing homes due to reimbursement options.

However, the new model, or as we call it PDPM, doesn’t place too much emphasis on therapy. Instead, nursing homes should pay attention to a specific code each resident has when entering relevant information within the software. You should understand the differences between RUG and PDPM, including:

  • RUG depends on therapy, while PDPM payments depend on medical diagnosis, the complexity of treatment, rare outcomes, and the overall condition of each resident.
  • PDPM is multi-disciplinary, while RUG focuses only on therapies.
  • You should know that RUG does not focus on outcomes, while PDPM depends on them. Therefore, it is a way better and more effective solution for residents within skilled nursing facilities or homes.

Check out this guide: to determine the range of data set with ease.

  • Remember that RUG requires five PPS assessments, while PDPM only one.
  • RUG comes with constant rates for the length of stay, while PDPM features Variable Per Diem adjustment, meaning you can adjust it over time to ensure the latest progresses that is happening.

The main diagnosis is not essential in RUG, while PDPM state that is vital to ensure each step along the way. It is a classification process of the resident or patient, which will allow nurses to create the most successful treatment plan by taking advantage of the software.

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