◂  July 2026

Webinar - Team MDS Series: MDS & Reimbursement Impact
7/28/2026

Presented By:

  • Sarah Becker RN RAC-CT, DNS-CT, QCP, Director of Clinical Reimbursement, Proactive LTC Consulting

Contact Person:

Proactive Medical Review and Consulting [email protected]

Course Description:

This session provides a clear overview of how MDS 3.0 coding accuracy directly drives reimbursement outcomes across Medicare Part A PDPM, Managed Care, and Medicaid Case Mix methodologies. Participants will explore the financial implications of assessment scheduling, Section GG accuracy, diagnosis coding, and clinical documentation. Emphasis will be placed on understanding how MDS data translates into PDPM components and Case Mix Index (CMI) scores, highlighting key strategies to optimize payment and maintain compliance with CMS and state audit expectations.

Learning Objectives

  1. Explain how MDS 3.0 coding impacts reimbursement under PDPM and Medicaid Case Mix methodologies.
  2. Identify common coding and documentation errors that negatively affect reimbursement accuracy.
  3. Apply strategies to ensure Section GG, diagnosis, and nursing coding reflect the resident’s true clinical picture.
  4. Analyzing the relationship between MDS assessment timing, accuracy, and facility financial outcomes

Course Content

  • 10 min: Introduction—how MDS data drives reimbursement across Medicare, Managed Care, and Medicaid.
  • 15 min: PDPM overview—mapping MDS items to PT/OT, SLP, Nursing, and NTA components.
  • 15 min: Medicaid Case Mix— Medicaid Case Mix methodologies, audit risks and considerations.
  • 10 min: Documentation and accuracy—IDT collaboration, Section GG, and ICD-10 coding precision.
  • 10 min: Case studies and Q&A—real-world reimbursement impact scenarios and practical coding strategies.

Target Audience:  MDS Coordinators, Directors of Nursing, Clinical Reimbursement Specialists, Administrators, and interdisciplinary team members involved in coding, billing, or case mix management.

Instructional Level: Intermediate

Program Length: 1 hour

List Learning Objectives: What participants will gain from attending this session:

Content: Bullet-point list of information covered to meet learning objective:

1.  Explain how MDS 3.0 coding impacts reimbursement under PDPM and Medicaid Case Mix methodologies.

  • Overview of how MDS items map into PDPM components (PT/OT, SLP, Nursing, NTA)
  • How Section GG functional scores influence PDPM rates
  • How Medicaid Case Mix Index (CMI) is calculated using RUG-IV, RUG-IV 48, or state-specific systems
  • Differences in methodology between Medicare A, Managed Care, and Medicaid CMI reimbursement
  • Case examples demonstrating financial outcomes tied to specific MDS coding decisions

2. Identify common coding and documentation errors that negatively affect reimbursement accuracy.

  • Frequent mistakes in Section GG, Section I, Section J, and Nursing qualifiers
  • Incorrect or incomplete diagnosis coding and the impact on PDPM Clinical Categories
  • Mismatched documentation that does not support MDS coding selections
  • Late, missed, or incorrectly sequenced assessments that reduce payment
  • Audit findings and trends from CMS and state Medicaid reviewers

3. Apply strategies to ensure Section GG, diagnosis, and nursing coding reflect the resident’s true clinical picture.

  • Best practices for interdisciplinary documentation to support usual performance coding
  • Ensuring accurate ICD-10 mapping to PDPM Clinical Categories and NTA comorbidities
  • Nursing qualifiers: definitions, criteria, and supporting documentation
  • Workflow strategies for capturing changes early and updating MDS coding appropriately
  • Examples of documentation that strengthens defensibility during audits

4. Analyze the relationship between MDS assessment timing, accuracy, and facility financial outcomes.

  • How assessment timing influences PDPM payment windows
  • Impact of missed or incorrect OBRA/PPS assessments on Medicaid Case Mix
  • IPA timing considerations and reimbursement implications
  • The financial effect of coding drift or declining accuracy over time
  • Real-world case studies showing revenue gains from improved coding and assessment processes

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