Failure to Timely Transmit MDS Assessment to CMS
Penalty
Summary
The facility failed to transmit a resident's Minimum Data Set (MDS) assessment to the Centers for Medicare and Medicaid Services (CMS) within the required 14-day timeframe after completion. Specifically, a resident who was admitted with diagnoses including urinary tract infection, diabetes mellitus, and cerebrovascular accident had an MDS 5-day scheduled assessment with an Assessment Reference Date (ARD) of 11/29/2024. The assessment was not submitted to CMS until 2/28/2025, which was well beyond the regulatory submission window. Record review and staff interview confirmed that the MDS Nurse was aware of the federal requirement to submit MDS assessments in a timely manner for accurate billing and compliance. Facility policy also required all MDS assessments to be completed and transmitted according to federal and state timeframes. The late submission was verified through the CMS MDS 3.0 NH Validation Report, which showed the assessment was transmitted more than 14 days after the ARD.