Cognitive Scoring impacts revenue under PDPM

The Brief Instrument for Mental Status (BIMS) and Cognitive Performance Scale (CPS) – is completed as part of MDS Section C and used to guide care planning of residents with confusion or a cognitive impairment. Under PDPM, Cognitive Scoring impacts revenue with an add-on to the SLP component for residents with a cognitive impairment based on the SLP resource utilization increases tied to this characteristic.

The difference between the highest possible and lowest possible SLP rate is approximately $80.06 a day. Across the 12 SLP Case-Mix Groups (CMG), payment impact for residents with a cognitive impairment will fall anywhere from roughly $7.03 – $21.54 per day.

Here are Proactive’s Top 5 Recommendations for accurately coding cognitive scoring under PDPM:

1) Review RAI language to facilitate consistent application of accurate processes for interviewing guidelines, BIMS basics including coding instructions, use of cue cards, quality of life considerations, and care planning

2) Dig into the facts. The difference between a score of 13 and a score of 12 on the BIMS impacts the SLP Case Mix Group (CMG.) Conduct the BIMS at an appropriate time of day, in an optimized environment, and using the most effective communication strategies for each individual resident so that the actual cognitive abilities are captured.

3) Know when to stop the interview:

  • All responses are nonsensical, or
  • There has been no verbal/written response to any of the questions, or
  • There has been no verbal/written response to some questions up to this point and for all others, the resident has given nonsensical responses

4) Implement a process to complete the CPS cognitive assessment even if the BIMS cannot be completed. In cases where neither the BIMS nor the staff assessment is completed, the patient will be considered “cognitively intact” for classification purposes under PDPM.

5) Check out Proactive Medical Review’s New Cognitive Assessment Toolkit which includes training video and Competency Resources as well as the other PDPM tools and training available here.

NEW Cognitive Assessment Toolkit

This Tool-kit is intended to be used to educate and measure competency of staff skill in appropriate assessment and coding the presence of cognitive impairment under PDPM. The tool-kit includes a complete staff development plan, inservice materials and instructor guide. Resources include a sample BIMS video to teach interview skills, resource items, pre/post tests, and a Competency Assessment Tool. Click here to learn more about this product in our shop.

NEW Updated Trauma Informed Care Toolkit

This Tool-kit is intended to supplement or enhance current SNF/NF educational programs for Restorative Nursing Programs to meet the intent of the new Requirements of Participation for competency based training. Click here to learn more about this product in our shop.

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Blog by Stacy Baker, OTR/L, RAC-CT, CHC, Director of Audit Services, Proactive Medical Review

Click here to learn more about Stacy and the rest of the Proactive team.