MDS Co-Pilot for Medicare Billing
Challenge
A skilled nursing facility (SNF) operator managing multiple facilities faced significant challenges in scaling their operations due to the complexity of the MDS (Minimum Data Set) Medicare submission process. Each facility required its own MDS coordinator, making it difficult to find, retain, and manage a sufficient number of qualified coordinators. High turnover rates among MDS coordinators led to inconsistencies and errors in critical MDS assessments, directly impacting the accuracy of Medicare reimbursements and, consequently, the revenue of the operator.
Approach
RTB-AI developed a custom AI-driven solution to address these challenges by partially automating the MDS submission process across all facilities. Understanding that MDS assessments are based on interpreting patient files, we trained an AI model to accurately read and analyze these documents. This AI was then integrated into a tool that could securely process patient information and automatically complete the MDS questionnaire.
The custom-built tool allowed users to upload patient documents, which the AI would analyze across the four MDS components, identifying conditions that qualified patients for specific Medicare categories. The tool also generated ICD-10 codes for each diagnosis. A key feature of the tool was its traceability; users could click on AI-generated responses to see the exact portions of the patient file that informed the AI’s conclusions, such as highlighting the text that indicated a patient required oxygen.
Impact
The implementation of this AI-powered tool allowed the SNF operator to scale their operations efficiently across multiple facilities. By automating the most time-consuming and error-prone aspects of the MDS process, the tool enabled existing MDS coordinators to complete two to three times more assessments than before. This increased productivity meant that as some coordinators left the organization, there was no need to backfill those positions, leading to significant cost savings.
With enhanced accuracy and efficiency, the SNF operator could maintain consistent and reliable MDS submissions across all their facilities. This not only ensured more accurate Medicare reimbursements but also stabilized and increased the operator’s revenue, allowing them to focus on providing high-quality care across their network of facilities.
