Q: As a Director of Nursing Services, what can I do to support the MDS department?
A: As a Director of Nursing Services (DNS), one of the best ways to support the MDS department is to treat MDS as an interdisciplinary clinical function, not simply as an administrative department. The DNS plays a critical role in ensuring the MDS coordinator has the clinical information, staff participation, and resources needed to produce accurate assessments and care plans.
Key Areas of DNS Support
1. Make MDS a Priority for the Entire Nursing Department
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- Reinforce that MDS is everyone’s responsibility—not just the job of the MDS coordinator(s).
- Educate nurses on the fact that their documentation directly affects MDS accuracy, care planning, quality measures, reimbursement, and regulatory compliance.
- Hold staff accountable for timely and accurate documentation.
2. Ensure the MDS Coordinator has Adequate Time
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- Avoid routinely pulling the MDS coordinator into unrelated staffing duties.
- Make sure there is adequate coverage for assessments, interviews, chart review, care plans, and required meetings.
- Monitor workload, particularly when there are multiple Medicare residents, significant changes, admissions, or discharge assessments.
3. Review Documentation—Not Just the Completed MDS
The DNS should periodically audit whether the clinical record clearly supports the MDS coding. Focus your review on supportive documentation for the following areas:
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- ADLs and Section GG documentation
- Falls and injuries
- Skin conditions and pressure injuries
- Weight loss
- Nutrition
- Behaviors
- Mood and cognition
- Continence
- Pain
- Respiratory conditions
- Infection
- Therapy services
- Restorative programs
- Physician diagnoses and orders
- Significant changes in condition
4. Monitor MDS Scheduling and Deadlines
Have a system for monitoring:
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- Assessment reference dates
- ARDs
- 5-Day PPS assessments
- OBRA assessments
- Significant Change assessments
- Discharges
- Quarterly assessments
- Care-plan completion
- Required interviews
- MDS transmission
A basic MDS calendar/dashboard routinely reviewed by the DNS and MDS coordinator and integrated into regular existing meetings can prevent avoidable scheduling and compliance problems.
5. Review Quality and Reimbursement Reports
The DNS should understand how MDS performance impacts the facility. Integrate reviews of the following into your regular workflow and consider what clinical practice and documentation drives outcomes in these areas:
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- QM trends
- QRP performance
- 5-Star-related measures
- MDS validation/error reports
- iQIES reports
- Medicare utilization
- Case-mix/reimbursement trends
- Changes in resident acuity
6. Protect the Integrity of the MDS
One of the most important DNS responsibilities is creating an environment where the MDS coordinator can code based on the clinical record and assessment findings, rather than pressure to achieve a particular reimbursement or QM outcome.
When rounding or reviewing a resident, consider whether the clinical record clearly corroborates the MDS. If there are discrepancies, investigate whether the problem is related to a breakdown in systems for documentation, communication, assessment, coding, or care delivery.
Ultimately, the DNS should create the infrastructure that allows the MDS coordinator to succeed. The MDS coordinator should not be expected to “find” clinical information after the fact—the nursing and interdisciplinary team should be consistently generating accurate, timely documentation that reflects the resident’s actual condition and care.
Next Steps: Join Proactive on September 15, 2026 for the webinar Understanding the MDS as part of the DON Playbook series to gain key insights into the DON’s role in supporting MDS accuracy and compliance and the significance of the MDS in nursing home operations.
Written By:
Brandy Hayes, RN, RAC-CT, RAC-CTA
Clinical Consultant
Proactive LTC Consulting
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