2026 RAI Manual Updates: Where MDS Teams Should Focus
Keeping up with RAI Manual updates is part of the job for MDS professionals. Finding time to understand what those changes mean for the work already in front of them can be harder. Assessments still need to be completed, documentation
Helping New MDS Team Members Know Where to Focus
Authored By Leslie Piper, Director of Clinical Reimbursement, TLC Management When someone is new to MDS, one of the hardest parts of the job is knowing where to focus. There is plenty of information to review, deadlines to meet, and a
Greater MDS Scrutiny Is Coming: How SNF Operators Can Prepare
Skilled nursing providers received welcome news in the FY 2027 final rule: a 2.4 percent increase in Medicare payment rates. But that increase came with a clear message. CMS is paying closer attention to whether growth in case mix reflects
Solving Healthcare Reimbursement Visibility Across States and Payers
If you operate across multiple states and multiple payers, you already know that reimbursement is not just complex, it is constantly shifting. Every state has its own nuances, Medicaid reimbursement complexity varies widely, managed care introduces another layer of variability,
AI in SNF Reimbursement: The Gap No One Is Talking About
AI in SNF reimbursement is everywhere in healthcare right now. For leaders responsible for reimbursement in skilled nursing, the real question is simple: does it actually change how teams operate? Reimbursement has become one of the most complex challenges in skilled
The Revenue Multiplier: How Reimbursement Oversight Scales
As skilled nursing organizations grow, reimbursement does not just become more complex. It becomes more consequential. More residents, more payers, and more documentation mean there is simply more at stake. Small gaps that once felt manageable in a single building start
How Windsor House Improved SNF Reimbursement Accuracy Without Adding Work for MDS Teams
For skilled nursing operators, reimbursement management has become one of the most complex and high-risk parts of the business. Medicare rules continue to evolve, Medicaid Case Mix Index plays a larger role in financial performance, Medicare Advantage plans apply inconsistent
Between the ARDs: Where Skilled Nursing Reimbursement Is Actually Lost
Why Strength on Assessment Days Is Not Enough If you ask an MDS or reimbursement leader where their process performs best, the answer is usually assessment days. ARDs are structured, scheduled, and receive focused attention. Most organizations execute them well. The challenge
Humana, Aetna, United: Same Resident, Different Rules
Medicare Advantage is often talked about as if it’s a single payer category. For skilled nursing teams doing the work every day, that framing doesn’t hold up. Humana, Aetna, United — the same resident, the same care, and three very different
CMS MDS QM Manual v18.0: Key Changes Operators Must Know
CMS has released the MDS 3.0 Quality Measures User’s Manual v18.0, effective January 1, 2026. The update is not a wholesale rewrite, but it introduces a few important changes that MDS and clinical leaders should understand. In this post, we’ll briefly