MDS Consulting Services for Skilled Nursing Facilities
The MDS decides what your Medicare and Medicaid claims are worth. We review the assessments before they cost you money — and train your coordinator so the next one is right without us.
Why MDS Accuracy Is a Revenue Problem, Not Just a Clinical One
Under PDPM, the assessment sets the rate. The primary diagnosis maps the PT, OT, and SLP components. Section GG drives the functional score. Comorbidities captured — or missed — move the NTA tier. A single unsupported score or an uncoded condition follows the resident through the entire stay, on every claim.
The difficult part is that nothing announces itself. There is no error message when a diagnosis is sequenced wrong or an ARD is set outside the window. The facility finds out months later, in an ADR, a denial, or a Quality Measure that quietly drifted — by which point the documentation that would have supported the claim is difficult to reconstruct.
It usually gets worse during turnover. When an experienced MDS coordinator leaves, the assessments keep going out on schedule, but the judgment behind them walks out the door.
What Our MDS Consulting Covers
We work alongside your MDS coordinator rather than replacing them — reviewing, validating, and training so the assessments hold up to scrutiny.
- Concurrent and retrospective chart review — assessments reviewed before submission where possible, and after the fact when you need to know what happened
- Section GG validation — functional coding checked against therapy notes, nursing documentation, and the actual record rather than habit
- ADL coding review — supporting documentation confirmed for the scores being reported
- PDPM component analysis — PT, OT, SLP, Nursing, and NTA reviewed individually so you can see where the rate is coming from
- Diagnosis capture and ICD-10 sequencing — primary reason for the SNF stay mapped correctly, comorbidities captured
- ARD scheduling and window management — assessment reference dates set deliberately instead of by default
- Interim Payment Assessment review — IPA decisions evaluated when a resident's condition changes
- Triple-check support — we review the clinical side of the claim ahead of the meeting and flag what needs attention
- Medicaid case-mix support — state-driven assessments reviewed where your state ties rates to the MDS
- Mock audits and ADR support — documentation reviewed against the assessments at issue before you respond
- MDS coordinator training and interim coverage — onboarding for a new coordinator, or coverage while the seat is empty
Payers and Processes We Cover
MDS work touches every payer differently. Here is what we review under each.
| Payer or Process | What We Cover |
|---|---|
| Medicare Part A (PDPM) | Component scoring, primary diagnosis mapping, NTA comorbidity capture, IPA decisions, variable per diem schedule |
| Medicaid (case-mix states) | State-driven assessment requirements, case-mix validation, supporting documentation review |
| Texas Medicaid | MDS submission sequenced so the LTCMI can be completed on the TMHP portal without delay |
| Managed care and MA plans | Level-of-care documentation and clinical support for authorization and appeal |
| OBRA and regulatory | Scheduling compliance, Quality Measure impact, and the clinical domain of Five-Star |
What Makes NHBS Different
What Changes When This Is Handled Properly
We will not publish a percentage we cannot support for your facility. What we can describe is what actually changes:
Assessments that hold up
Scores are supported by documentation in the record, so an ADR or audit becomes a retrieval exercise rather than a scramble.
Fewer surprises downstream
Diagnosis and component issues get caught during the assessment window instead of surfacing as a denial a quarter later.
A coordinator who is steadier
Training and review build judgment. New coordinators come up to speed faster and second-guess themselves less.
MDS Consulting FAQs
Do you replace our MDS coordinator?
No. In almost every engagement we work alongside the coordinator you already have. We review, validate, and train — the coordinator keeps ownership of the assessments.
The exception is interim coverage, when the position is vacant and you need someone to keep assessments going out on time while you hire.
Our MDS coordinator just resigned. Can you cover the gap?
Yes. We provide interim MDS coverage while you recruit, and we can onboard the person you hire so the transition does not cost you a quarter of accuracy.
How is the review done?
Remotely, through your clinical system. Chart review, Section GG validation, PDPM analysis, training, and mock-audit support are all handled without anyone needing to be on-site.
We are already under ADR or audit. Is it too late?
No, and this is a common reason facilities call us. We review the documentation supporting the assessments at issue and help you understand what the record actually supports before you respond.
Do you work in PointClickCare, MatrixCare, or our system?
Yes. We work inside the clinical and billing systems you already use rather than asking you to export data into ours.
How does this connect to Texas LTCMI?
Directly. In Texas, the LTCMI can only be entered after the federal MDS 3.0 assessment has been submitted to CMS and extracted to the TMHP LTC Online Portal, which generally takes 24 to 48 hours. If the MDS is late or has to be corrected, the LTCMI waits — and so does Medicaid payment.
Texas facilities usually engage both services together for that reason.
MDS and LTCMI Work in Sequence
For Texas nursing facilities these are not two separate projects. The LTCMI can only be entered after the federal MDS 3.0 assessment has gone to CMS and been extracted to the TMHP LTC Online Portal — typically 24 to 48 hours later. When one side slips, the other stalls.
Have Us Review a Few Assessments First
No obligation, no long-term contract. We will look at a sample of recent assessments and tell you plainly what we see.