In 2020, skilled nursing facilities (SNFs) are tracking numerous clinical, financial and quality measures for internal benchmarking, as well as for reporting to and complying with governmental agencies. Given the sheer volume of data generated by SNFs of all sizes, and the many ways such data could be utilized, Richter’s clinical consulting services team recently undertook a process to create performance initiatives that target five high-risk areas in the SNF setting and provide proactive mitigation of those risks.
In this blog, we shine a light on Case Mix Index (CMI), an area of key importance for SNFs of all sizes.
One of the most pressing issues in skilled nursing reimbursement is adjusting payments to the patients’ care needs (also known as Case Mix Index (CMI)). CMI is a relative value assigned to individual patients in an SNF facility. That value in aggregate, in turn, is used to determine the allocation of resources to care for and/or treat patients in the facility. Essentially, case mix reimbursement was designed to tailor payment amounts to acuity in a facility.
Capturing case mix-related items on the MDS can be a challenge for MDS nurses and may require additional assessments to be completed during the quarter. The job of an MDS nurse entails finding the seven-day period during any given quarter that the resident is receiving the highest amount of care and treatment, and then completing an MDS for that time frame. This requires both skill and attentiveness by the MDS nurse in order to capitalize at the right time.
Recently, states have taken the lead in adjusting for case mix. In most states (including Ohio, New York, Wisconsin, Georgia and New Hampshire, to name a few), case mix is a factor in determining Medicaid reimbursement. Optimizing CMI, therefore, can potentially help streamline and increase the overall reimbursement for your SNF.
In the end, boosting your SNF’s CMI is key to increasing revenue.
Do you have questions about boosting CMI, the five SNF target areas identified by Richter, or other clinical challenges? Read our e-book, “Optimizing Five Target Areas in Skilled Nursing Facilities – Your Key to Success” or call Richter’s skilled nursing facility consultants at 866-806-0799 to schedule a free consultation.
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Jennifer Leatherbarrow RN, BSN, RAC-CT, IPCO, QCP, CIC, is Manager of Clinical Consulting for Richter.