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What is an MDS Nurse?

Updated: Jan 22


An MDS nurse does MDS (Minimum Data Set) assessments in Skilled Nursing Facilities (SNFs) or Long Term Care Facilities (LTCs). These facilities can also be termed as skilled rehab facilities, nursing homes, convalescent hospitals, rehab and wellness centers, transitional care units or post-acute care facilities. MDS assessments are done according to strict schedules set by the Center of Medicaid and Medicare Services (CMS). These assessments have questions that need answers collected from different observation periods during the resident's stay and coded on the MDS assessment form itself or encoded into an MDS program. The answers need to be accurate and involve interviewing patients (residents) or their family, assessing the resident, reviewing the whole chart, reviewing other medical records not in the chart yet (narcotic record, treatment sheets, therapy treatment logs, ADL charting by CNAs, RNA logs and vaccination logs) and interviewing staff involved in the resident's care during all shifts. A click to answer the MDS that a COPD resident has shortness of breath when lying down can affect a Medicare reimbursement of almost $200 more PER DAY than if an MDS nurse only clicked on "oxygen use". Yes, MDS nurses are that important.

An MDS nurse coordinates with the Interdisciplinary Team for timely MDS assessment completion. Coding, calculating, signing, completing and transmitting the MDS depend on specific instructions and, at times, over-lapping time frames of due dates explained in the Resident Assessment Instrument (RAI) User's Manual. The RAI manual is released by CMS and is revised accordingly.

An MDS nurse does care plans. Completing the MDS depends on the type of MDS assessment scheduled that is due; therefore, the MDS nurse usually sets up certain MDS completion to parallel which resident is scheduled for the Care Plan Meeting or IDT meeting scheduled in these facilities. For example, if a resident had an Admission MDS due, that Admission MDS gets completed and helps determine what needs to be added to the care plan to complete the care plan already initiated by the team. Afterwards, the MDS nurse notifies the Interdisciplinary Team that the resident will be listed for upcoming care plan meeting.

An MDS nurse may or may not be the lead in care plan meetings depending on the company's policy or the MDS workload. During the care plan meeting, the resident's and/or the responsible party's preferences, input or concerns are updated in the care plan. Then, the lead of the care plan meeting shares the concerns brought up in the care plan meeting with the appropriate staff for follow-up. Short-term stay residents may not give enough time for care plans to be completed; therefore, these residents may not be included in care plan meeting schedule.

An MDS nurse may be involved with the following tasks, depending on the facility policy or size:

- Be part of QA meeting: To help improve Quality Measures

- Coordinate Medicare Part A, B and HMO meetings

- Staff Education: In-services regarding proper ADL or skilled documentation

- Triple check: Monthly review of Medicare Part A billing accuracy

- One of the most important and rewarding tasks: Communicating to the appropriate team member the resident's preference or issue, following up if interventions were effective, seeing the positive outcome and improving the resident's quality of life.

To answer the question "What is an MDS nurse?" MDS nurses are just that... that important. Interested in learning MDS? Visit www.mdsadvisor.org

Related article: "Who Can Do MDS Assessments?" and other articles.

#MDSNurse #ResidentCareCoordinator #MDSCoordinator #MDSStaff #MDSNurseResponsibilities

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