Nursing Facility Case Mix Rate Setting
■ MINIMUM DATA SET (MDS) DATA MANAGEMENT
Myers and Stauffer’s work with the MDS began with the federal case mix demonstration project in 1989 and continues through to the present MDS Version 3.0. Our services include:
- Developing Resource Utilization Group (RUG) classifications.
- Developing case mix indices (CMI) and resident rosters.
- Maintaining help desk services to assist providers.
- Developing management reports to assist in monitoring assessment trends and tracking impact on rates.
- Providing training programs and materials for all providers on RUG classifications and case mix reimbursement.
■ REIMBURSEMENT DESIGN/MAINTENANCE
Myers and Stauffer is the expert in designing and implementing case mix reimbursement approaches that target payments to critical resource use. With the most extensive Medicaid nursing facility case mix reimbursement experience in the nation, we are able to:
- Model system design options for quick and efficient evaluation.
- Develop a comprehensive case mix rate setting system that consists of a database of statistical, financial and rate information.
- Develop rate add-ons and incentive payments linked to the desired MDS data or quality outcomes.
- Consult on cost reporting, definitions of allowable costs and other reimbursement issues.
- Assist with presentations to various stakeholders.
- Assist with drafting of state plan, Medicaid reimbursement regulations and provider handbooks.
- Assist in responding to the Centers for Medicare and Medicaid Services on state plan amendments.
- Develop provider training programs and materials on nursing facility rate setting.
- Evaluate and recommend necessary changes to Upper Payment Limit calculations.
■ SYSTEM UPDATES
As circumstances change and systems evolve, we remain on the leading edge of new developments and stand ready to assist our clients with challenging business decisions. One primary example is the transition from MDS 2.0 to MDS 3.0, as federally mandated. During this transition, our clients also ask the question of whether to transition to the RUGs IV system from the RUGs III system. We are able to assist clients in this decision by performing the following analysis:
- Using the MDS 3.0 data, process data through the RUGs IV grouper.
- Arrive at CMIs under the RUGs IV system.
- Develop rates using updated CMIs.
- Perform fiscal impact analysis comparing the rates produced under existing RUGs III case mix system and the updated RUGs IV case mix system.