MDS & PDPM Optimization
Proactive MDS review to identify undercoded conditions and maximize your Medicare case mix index — ensuring your payment rate accurately reflects every resident’s true clinical acuity.
Our Services
Additional Details
Tell us about your facility’s MDS challenges or PDPM case mix index concerns…
Your Medicare Rate Starts with Your MDS — We Make Sure It Reflects Your Residents.
Under the Patient-Driven Payment Model, your Medicare reimbursement rate is determined almost entirely by the accuracy and completeness of your MDS assessments. Every diagnosis, functional score, and clinical condition documented on the MDS translates directly into a PDPM payment component. A missed diagnosis or an incomplete assessment does not just affect one resident — it suppresses your facility’s overall case mix index and reduces your Medicare revenue for the entire payment period.
LTC Billing’s MDS and PDPM optimization service bridges the gap between your clinical team’s documentation and your billing team’s revenue output. We conduct regular MDS review sessions, identify undercoded diagnoses and missed clinical conditions, and work directly with your MDS coordinator to ensure every resident’s assessment accurately reflects the care they are receiving — and that your facility is paid accordingly.
What’s Included
PDPM Case Mix Index Review & Analysis
We analyze your facility's current case mix index by PDPM component — PT, OT, SLP, nursing, and non-therapy ancillary — identifying which components are underperforming relative to your clinical census and where undercoding is suppressing your payment rate.
MDS Assessment Timing & Scheduling Audit
We review your MDS assessment schedule for timing accuracy — ensuring all required assessments are completed within the correct reference date windows and that no missed or late assessments are creating payment rate gaps.
Diagnosis Code Review & ICD-10 Optimization
We review each resident's active diagnosis list against their MDS documentation, identify missing or undercoded ICD-10 diagnoses that affect PDPM classification, and work with your clinical team to ensure all relevant conditions are captured.
Clinical Documentation & MDS Coordination Support
We work directly with your MDS coordinator, DON, and therapy team to align clinical documentation with billing requirements — ensuring that the care your facility provides is fully reflected in both the MDS and the Medicare claim.
Monthly CMI Reporting & Rate Impact Analysis
We deliver monthly case mix index reports showing your CMI by PDPM component, projected Medicare revenue impact, and specific optimization opportunities — giving your administrator and DON a clear picture of where revenue is being left on the table.
Our Process
01
Census & CMI Baseline Review
We pull your current census and calculate a baseline CMI by PDPM component to identify where undercoding is occurring.
02
MDS & Diagnosis Audit
We review each resident’s MDS documentation and ICD-10 diagnosis list for missed or undercoded clinical conditions.
03
Clinical Team Coordination
We work with your MDS coordinator and DON to capture missing diagnoses and correct assessment documentation before billing.
04
Monthly CMI Reporting
We deliver monthly case mix index reports with revenue impact analysis and actionable optimization recommendations.
Why MDS Accuracy Directly Determines Your Medicare Revenue
Under PDPM, Medicare no longer pays based on the volume of therapy minutes delivered. It pays based on the clinical characteristics of each resident — as documented on the MDS. That means a resident with a stroke, dysphagia, and a non-healing wound should generate significantly higher Medicare revenue than a resident whose MDS only captures a hip fracture. If your MDS coordinator is not capturing every relevant diagnosis and clinical condition, your facility is being paid less than it is owed — not because of a billing error, but because of a documentation gap.
For a 100-bed Illinois SNF with 25 Medicare residents, a case mix index improvement of just 0.10 points can generate $15,000 to $25,000 in additional monthly Medicare revenue — from the same clinical census, with the same residents, providing the same care. LTC Billing’s MDS optimization service is designed to close the gap between what your facility’s clinical team is doing and what your MDS documentation is capturing — turning existing clinical complexity into the Medicare revenue your facility has already earned.