case mix question

  1. Hey all, in our building, they expect our case mix to be 2.3 whole house and 2.3 caid only. We only have 148 beds and maybe run an average of 4 medicares. We also do not have alot of things such as IVs. I was just curious what other peoples' case mixes are out there, and how are you doing it?? Thanks!
  2. Visit chlori profile page

    About chlori

    Joined: Jun '06; Posts: 16; Likes: 10
    clinical reimbursement
    Specialty: 11 year(s) of experience in Long term care


  3. by   Nascar nurse
    Hi. You don't indicate what state you are in and from the numbers you have posted, it must be VERY different from state to state. I am in Indiana and to get a case mix score of 2.3, would take 99% of all residents being in SE2 or SE3 - which is NEVER going to happen. Our highest ever was 1.21 - which won us highest in our local "regional" facility goal. Currently we are at about 1.15. Of course we make sure we get all the IV's, IV fluids, respiratory treatments, physician visits/orders, etc. We also make sure the calendar is posted well enough ahead of time and work closely with therapy (and all other departments) to see if anyone coming up may need a part B eval/tx. Try to capture all the therapy we can get.

    Current daily medicare book rate is about $450/per patient per day. That is with most/all of residents being in RU for therapy and being very aggressive about getting those IV meds w/ intent of capturing on 5 day as well as 14 day when possible. (This rate also varies with location. Somewhere on another MDS thread someone has posted a web site to look up all reimbursement {Medicare} levels according to location. You may want to search for this - I found this very interesting.)
  4. by   Nascar nurse
    I found it - thank you to the original poster - cool site. :spin:
  5. by   chlori
    Thanks for the input. I guess things are different state to state. I am from Ohio and I believe the average case mix score is 2.0 with our midwest buildings. Interesting how medicaid does things. Well, talk to ya later! Im about 2 years new to MDS and I love talking about it, so write back anytime
  6. by   nursenikki928
    I am also in Ohio and our goal is a 2.0 for both Medicare and Medicaid. Im usually at about 1.9 on the Medicaid and 2.1 on the Medicare. We have 115 beds, and average about 20 part A's per day. Im also the only MDS nurse with a part time person to help with the care plans!
  7. by   chlori
    Oh my, I bet you are BUUUUSY! What part of Ohio are you in, what facility? We may be neighbors
  8. by   nursenikki928
    Northeast Ohio, Ashtabula County
  9. by   meghan61
    We are in Upstate NY and just brought our Medicaid rate up to 0.92 from 0.86. I found that we were missing a significant number of Dr visits/order changes, so we corrected that during our last assessment period. I also found that some hemiparesis/plegia's had been omitted and some nurses are coding the hemi's as ICD-9 codes on I.3. instead of I.1. Some of our nurses excluded Oxygen because it was not used daily, (the old PRI criteria).
    We started having CMI meetings to educate the nurses.
  10. by   amglpn
    Thanks for the site Great info!!
  11. by   donna17
    Do you have any information that you would be willing to share regarding CMI?

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