Inovalon MDS Intelligence is a specialized Minimum Data Set (MDS) assessment software designed for skilled nursing facilities (SNFs), long-term care hospitals (LTCHs), and inpatient rehabilitation facilities (IRFs). It is a cloud-based solution, part of the larger Inovalon ONE® Platform, that focuses on ensuring data integrity, maximizing reimbursement, and strengthening regulatory compliance.
Product Overview and Key Benefits
The software moves beyond basic MDS scrubbing tools by leveraging powerful clinical analytics to draw insights from MDS data, thereby improving resident care and financial performance. Its core value proposition is to eliminate last-minute scrambles, reduce manual rework, and provide the confidence of accurate, compliant submissions every quarter.
Key benefits include:
- Protect Revenue: Ensures Case Mix Index (CMI) accuracy aligns with nursing hours to maximize Patient-Driven Payment Model (PDPM) reimbursements.
- Stay Survey-Ready: Provides tools like a resident matrix and real-time quality performance monitoring to align reporting with CMS expectations.
- Save Staff Time: Automated checks, logic flags, and clear reporting dashboards reduce manual review and data cleanup.
- Strengthen Compliance: Helps organizations navigate the complex regulatory landscape, reduce the risk of federal tags, and monitor SNF star ratings in real-time.
Main Features and Capabilities
- Automated Validation (Logic Flags): Unlimited uploads and automated flags catch inconsistencies and errors in MDS assessments before submission deadlines.
- Integrated iQIES Submission: Allows for direct submission of assessments to CMS via the integrated iQIES system for fast, accurate transmissions.
- PDPM Calculator: Built-in tool to predict and optimize revenue potential and estimate Interim Payment Assessment (IPA) daily rates.
- Quality Measure Benchmarking: QM Benchmark dashboard to track performance against state norms and other MDS Intelligence facilities.
- Clinical Watch Pages: Monitor and track resident status trends (e.g., "Improved" or "Deteriorated") to identify necessary interventions.
- Facility Assessment Resource: Robust tool to help with the complexity of completing government-required Facility Assessments.
- Enterprise Reporting: Provides an overview of flags triggered, benchmarks, and MDS status across the organization.
Target Users and Use Cases
Target Users: MDS Coordinators, Clinical Compliance Managers, Facility Administrators, and Finance/Revenue Cycle Management teams in post-acute care settings.
Use Cases:
- MDS Accuracy & Submission: Validating, correcting, and submitting MDS assessments to CMS (iQIES).
- Reimbursement Optimization: Leveraging the PDPM calculator and CMI alignment to ensure accurate, maximized Medicare reimbursement.
- Survey Preparedness: Using data and reporting tools (like the resident matrix) to prepare for CMS surveys and reduce risks for survey tags.
- Quality Improvement: Monitoring quality measures and SNF Five-Star ratings to drive continuous improvement (QAPI initiatives) and improve resident outcomes.