Underreporting Functional Scores and Nursing Components

$100,000-$180,000 annually per facility (MCO audit findings + lost PDPM revenue from coding errors; ~2-3 MCO audits annually with $50,000-$60,000 per audit impact) • $100,000-$200,000 annually per facility (state audit penalties + missed NTA revenue from incomplete initial assessments) • $12,000-$35,000 monthly in delayed payments from Medicaid denials and resubmissions; $80,000-$250,000 annually in lost revenue from lower RUG classification due to unrecorded functional decline or missed NTA points; compliance risk (potential recoupment)

Admissions Director relies on intake information only; no systematic review of hospital records or historical functional data before MDS completion; higher PDPM group opportunity missed at admission • Admissions Director uses generic intake form; MDS Coordinator later discovers missing state-required assessments; late amendments submitted; state audit penalties issued • Billing Manager flags missing IPAs retroactively; requests clinical staff submit late IPA; submits post-discharge amendment; hopes for payment adjustment approval