Q: Due to staffing shortages, we’ve had to pull our MDS nurses to provide direct care, and assessments are getting behind. What can we do to maintain CMI and Medicare reimbursement?

A: Call me the bearer of bad news, but the answer is “not much.” The more time the MDS nurse spends completing “other duties as assigned,” the less time he or she has to focus on oversight of care quality and reimbursement. I completely understand and firmly agree that patient care should come first, but when the facility’s reimbursement experts are busy elsewhere, it should be no surprise that case mix index (CMI) may wane, and assessments, including those required for Medicare billing, might be late or missed. 

As you continue to address the root cause of the issue — staffing — you may consider bringing in some outside assistance. Many facilities have been able to maintain a focus on reimbursement accuracy by employing short-term, remote MDS help to assist in keeping the MDS coordinator’s workload manageable. Not only can this keep the MDS schedule on track, but it can also save you from unintentionally pushing your MDS nurse out the door from sheer exhaustion. Filling an empty position is the last thing you need. 

If staffing is not in crisis, another welcomed practice is cross-training others to complete MDS duties. One of the biggest pet peeves for an MDS coordinator is the feeling that they can help on the floor, but no one can help them in return. Others trained in the role can offer reciprocation when direct care is assigned. 

If you haven’t already, consider a data analytics platform. As an ongoing tool in your belt, such software can identify common coding errors and other areas of data inaccuracy to maximize MDS accuracy.