Under PDPM, accuracy on the MDS isn’t just a compliance checkbox — it’s directly tied to your facility’s reimbursement. A single miscoded item can shift a resident’s case-mix classification and quietly cost your facility thousands of dollars per stay.

Here are five of the most common (and most costly) errors we see in skilled nursing facilities.

1. Incorrect Primary Diagnosis Mapping Selecting an ICD-10 code that doesn’t map cleanly to a PDPM clinical category is one of the most frequent errors. When the primary diagnosis doesn’t reflect the resident’s actual reason for skilled care, the entire PT/OT/SLP classification can be thrown off.

2. Miscoded Section GG Functional Scores Section GG drives both the PT/OT and Nursing components of PDPM. Inconsistent scoring between disciplines, or scoring based on assumption rather than observed performance, routinely under- or over-represents a resident’s functional status.

3. Missed NTA Comorbidities the Non-Therapy Ancillary component is one of the largest reimbursement drivers in PDPM, yet comorbidities are frequently under-captured because they aren’t clearly documented in the medical record before the assessment is coded.

4. Inaccurate ARD Selection Choosing the wrong Assessment Reference Date — or missing the optimal window — can lock in a lower-paying classification for the entire payment period, even when the clinical picture would have supported a higher one.

5. Restorative Nursing Coding Gaps Missing documentation for the required frequency and duration of restorative nursing programs is a common, avoidable error that directly affects the Nursing component score. Getting these five right consistently takes trained eyes and ongoing practice. That’s exactly what our MDS 3.0 Certificate Program, Restorative Nurse Certificate Program, & MDS 3.0 Masters I, II is built to teach — and where our PathPoint Clinical Partners team can step in when your facility needs interim coverage.