MDS 1
A resident scores 14 on the BIMS but is dependent for toileting hygiene and toilet transfers. Which CAA is likely to trigger due to the discrepancy between cognition and function?
✅ Answer: Functional Abilities and Goals CAA
What is the look-back period for most MDS items?
✅ Answer: 7 Days
Which publicly reported QM tracks residents who experienced one or more major injury falls?
✅ Answer: Long-Stay Major Injury Falls QM
Which MDS section contributes directly to Falls with Major Injury QM?
✅ Answer: Section J (Falls)
True or False: Therapy minutes determine PDPM reimbursement.
✅ Answer: False
For a resident coded as always incontinent of urine and bowel, which MDS section captures continence status?
✅ Answer: Section H (Bladder and Bowel)
A resident has an indwelling urinary catheter. How is urinary continence coded?
✅ Answer: 9 = Not Rated
This QM is impacted when residents receive antipsychotic medications without an appropriate exclusion.
✅ Answer: Percentage of Long-Stay Residents Receiving Antipsychotic Medications
True or False: Quality Measures are calculated directly from MDS data submissions.
✅ Answer: True
What does NTA stand for?
✅ Answer: Non-Therapy Ancillary
What is the maximum score possible on the BIMS?
✅ Answer: 15
What MDS section captures falls?
✅ Answer: Section J
Which MDS section primarily impacts the Long-Stay Pressure Ulcer QM?
✅ Answer: Section M
Name one area where strong nursing documentation can prevent QM inaccuracies.
✅ Answer: Any of the following:
Falls
Pressure injuries
ADLs
Antipsychotic use
Incontinence
Weight loss
Which nursing category generally produces the highest nursing reimbursement?
✅ Answer: Extensive Services
A resident reports little interest or pleasure in doing things and receives a PHQ-9 score of 12. Which CAA will trigger?
✅ Answer: Mood State CAA
What section captures pressure injuries and skin conditions?
✅ Answer: Section M
What is the single most important factor in QM accuracy?
✅ Answer: Accurate MDS coding and supporting documentation
Question (50 Points)
A resident falls and fractures a hip.
Nursing documents the fracture.
The MDS codes J1800 = No Falls.
What QM is affected?
✅ Answer:
Major Injury Falls QM
One coding error can negatively impact Five-Star performance.
A resident has:
Diabetes with insulin
COPD
CHF
ESRD
Malnutrition
What PDPM component should receive the greatest scrutiny?
✅ Answer:
NTA
Multiple diagnoses significantly increase NTA points.
A resident answered all BIMS questions correctly except recalled only 1 word. What is the BIMS score?
✅ Answer:
Repetition = 3
Year = 3
Month = 2
Day = 1
Recall = 2
0
0
Total = 11
Moderately Impaired Cognition
What is the purpose of a CAA?
✅ Answer: To identify, analyze, and determine whether triggered issues require care planning.
A resident had:
Weight loss
Tube feeding
Significant swallowing disorder
But the MDS missed coding K0100D.
Which QM and PDPM area may be affected?
✅ Answer:
QM:
Weight Loss
PDPM:
SLP Component
Missed coding may reduce reimbursement and affect quality outcomes.
A resident receives an antipsychotic medication.
Diagnosis:
Depression
Anxiety
No schizophrenia, Huntington's Disease, or Tourette's syndrome.
Which QM is at risk?
✅ Answer:
Long-Stay Antipsychotic QM
The resident will likely be included in the numerator.
A resident has:
COPD
Oxygen
Respiratory failure
Feeding tube
Stage 4 pressure injury
Which two PDPM components should be reviewed first for potential under-capture?
✅ Answer:
Nursing
NTA
Both components may contain significant reimbursement opportunities