How One ARD Error Can Wipe Out $2,000 in PDPM Revenue

In the high-stakes world of post-acute care, accuracy is everything. One of the most overlooked errors that directly impacts reimbursement is the incorrect assignment of the Assessment Reference Date (ARD). A single mistake can lead to tens of thousands in missed revenue—yet this is still one of the most common issues SMK Medical identifies during our MDS audits.

What Is the ARD and Why It Matters

The Assessment Reference Date (ARD) sets the timeline for the Minimum Data Set (MDS) assessment period. This date determines when clinical conditions and services are captured, which directly drives case-mix and PDPM reimbursement. When the ARD is chosen incorrectly or without clinical insight, providers risk:

• Underreporting skilled services
• Missed reimbursement opportunities
• Inaccurate Quality Measures (QMs)
• Potential survey scrutiny
• HIPPS code changes that reduce payment

How ARD Timing Impacts PDPM Rates

PDPM case-mix components are sensitive to when the ARD is set. ARD timing affects more than just assessment schedules—it impacts reimbursement directly in several ways:

• NTA (Non-Therapy Ancillaries): Many NTA points must be captured within the first 3 days of the resident stay. An ARD that is set too late can cause critical NTA conditions (like isolation, IV meds, or ESRD treatments) to be missed, costing thousands in lost payment.
• Nursing Component: Services like depression indicators, behavioral symptoms, or certain medical treatments must be documented in alignment with the ARD window. A missed ARD can mean a lower nursing classification.
• Functional Score: The resident's ADL performance must be captured correctly. Setting the ARD too early or late can skew the score and reduce payment.
• IPA (Interim Payment Assessment): Without monitoring for clinical changes that trigger an IPA, facilities often miss updated acuity that would justify a higher PDPM rate.

Real-World Example: The Cost of a Missed ARD

In one recent audit, an SNF failed to adjust the ARD after a patient showed clinical improvement. By setting the ARD just three days early, they missed the window to capture higher-functioning therapy minutes and comorbidities. The result? A $1,980 loss on just one PPS 5-day assessment. Multiply that across even 10 admissions, and you're looking at nearly $20,000 of missed reimbursement.

How ARD Mistakes Happen

• Lack of coordination between clinical and MDS teams
• Turnover or absence of a seasoned MDS nurse
• Rushed admission processes
• Untrained staff assigning the ARD without fully understanding the case mix impact

What CMS Says About It

According to the RAI Manual, the ARD must be selected with care to ensure all clinically relevant information is captured. CMS holds facilities accountable for both accuracy and timeliness. Improper ARD dates can also flag facilities for audit or trigger citations during survey.

The SMK Medical Solution

At SMK Medical, we specialize in preventing these costly oversights. Whether your team is short-staffed or simply needs a second set of expert eyes, we offer:

• 48-Hour MDS Nurse Guarantee: We deploy experienced MDS nurses in under 48 hours when you're in crisis.
• Free MDS Utilization Review: We analyze your assessments to ensure you're not leaving money on the table.
• Expert Education: Access free MDS training at our sister site, mdseducation.com, designed to empower your staff with real-world knowledge.

Final Thoughts Your revenue and compliance hinge on the accuracy of your assessments. Don’t let ARD errors go unchecked. A proactive review today can prevent major losses tomorrow.

Need Help? Don't leave money on the table or risk another citation. SMK Medical is the nation's most trusted partner for MDS support, survey readiness, and clinical compliance. Whether you need an emergency MDS nurse in 48 hours, a utilization audit, or expert training — we deliver.

👉 Visit SMKMed.com or call 313-314-8267 to protect your revenue and stay survey ready.

Disclaimer:

The information provided on this blog by SMK Medical is for general informational purposes only. We are not liable for any actions that were taken based on the information provided. Please consult with a qualified professional for specific advice.