Minimum Data Set (MDS)
The MDS is the comprehensive clinical assessment tool required for all Medicare and Medicaid residents in skilled nursing facilities, driving PDPM payment classification, Five-Star Quality Rating calculation, and CMS quality reporting.
What is the MDS?
MDS 3.0, the current version of the assessment tool, contains more than 450 data items organized into labeled sections. Section A captures resident identification and admission information. Section B assesses hearing, speech, and vision. Section C evaluates cognitive patterns. Section D uses the PHQ-9 (Patient Health Questionnaire-9) to screen for depression. Section GG — Functional Abilities and Goals — is the most payment-critical section, capturing mobility and self-care functional performance codes that drive PDPM case mix group assignment. Section I records active diagnoses (primary and secondary). Section J documents health conditions including pain and fall history. Section K assesses swallowing and nutritional status. Section M captures skin conditions including pressure injury staging. Section N records medication use including psychoactive drug patterns, which feed directly into the antipsychotic medication quality measure. The MDS assessment schedule includes: a 5-day PPS assessment (completed on day 5–8 of the Medicare stay), quarterly reviews, an annual comprehensive assessment, a significant change in status assessment when warranted, and a discharge assessment. PDPM payment is determined by the MDS classification — specifically Sections I (diagnoses), J (health conditions), GG (functional abilities), and B (cognitive function). A coding error in a single GG item can shift a resident to a lower-paying PDPM case mix group, directly reducing daily reimbursement for the entire payment period.
Why It Matters for Healthcare Analytics
MDS accuracy is the foundation of SNF financial and quality performance. Every quality measure in the CMS Five-Star Quality Measure star rating — including pressure injuries, falls with major injury, antipsychotic medication use, and pain — is derived entirely from MDS data. A facility with accurate MDS coding has accurate quality measures; one with systematic coding errors has both inaccurate quality scores and misclassified PDPM payments.
How Vizier Tracks MDS
Upload your MDS assessment data, then ask "Which of our PDPM case mix groups are below expected payment levels and which Section GG items are outliers compared to national benchmarks?" — Vizier analyzes PDPM classification distribution, identifies coding gaps in high-value sections, and tracks the Five-Star quality measures derived from your MDS data.