On the surface, keeping Medicare-required MDS assessments on track appears to be one of the easier components of the PPS process. However, “in practice, it is a struggle everywhere for a number of reasons, including how quickly many residents come into and depart from facilities,” says Carol Maher, RN-BC, RAC-CT, director of clinical reimbursement at Ensign Facility Services, Inc., in Mission Viejo, CA.

With the August publication of the skilled nursing facility (SNF) PPS and consolidated billing final rule for fiscal year 2009, CMS finally ended more than one year of confusion regarding when SNFs can bill the Medicare Part A default rate if a PPS MDS assessment hasn’t been completed and accepted into the state database, says Rena R. Shephard, MHA, RN, RAC-MT, C-NE, founding chair and executive editor of the AmericanAssociation of Nurse Assessment Coordinators and president of RRS Healthcare Consulting Services in San Diego.