Medicare & Medicaid Standards Automation - an Idea That Works

Medicare & Medicaid standards automation

There is a popular idea among all Healthcare projects that is always in with a chance to get amazing feedback from potential users. This idea refers to automation of CMS (Medicare and Medicaid) standards and is great because it addresses CMS-related problems at medical facilities.

I participated in three projects of the kind described above. I used to automate MDS 3.0 forms, OASIS forms and care plans. These standards should be implemented by facilities that get reimbursed for medical services. All of them have something in common.

Problems to be solved

When dealing with CMS documents, medical facilities face the following problems:

  1. The documents are huge, I mean, they are HUGE! MDS 3.0 consists of 800 plus fields, OASIS forms have around 450 fields. Care plans have hierarchical structure, therefore even if a care plan consists of 50 items, all of those items have a few parental items so the total number of records in the care plan should be multiplied by four.
    The problem is that every document takes significant time to fill it out. One of our clients once told me that his wife had tried to fill out an OASIS form manually without using any software and it took a week to get the form completed!

  2. Facilities should generate multiple documents of the same kind for each patient. In other words, a patient should have an updated care plan every week, a new MDS form every other week. OASIS is sent less frequently, but it also is periodic in nature and should be sent to the insurance companies several times per year.
    The problems is that nurses in medical facilities do not remember which document for which patient should be generated today or tomorrow. It is worth mentioning that they have other work besides filling out regimented forms. Like caring about people.

  3. The documents may be valid or invalid depending on how they are generated. There are consistency rules for each standard. And again, the rules are too many! MDS 3.0 has more than 200 rules that guarantee consistency of the document.
    The problem is that even if a form is filled out and sent to CMS, it may be rejected if not consistent. It means that if anything is wrong, the facility will not be reimbursed.


Obviously, such problems are significant for every medical facility. But the good news is that these problems can be solved by a properly designed medical automation software. Software automation is natural when it comes to processing such highly structured forms and documents.

A good CMS automation software should address the problems described above. In particular, it can have the following features:

  1. Automatic form filling-out. Of course, when a new patient becomes a client of the facility, the nurses will have to spend time on the new person and enter the new data into the software. But they will be happy to do it because getting a new client is a good deal. Once the initial data is entered, all other forms and documents can be pre-filled out with it. Also, new documents can be pre-filled out by the information that can be found in the earlier documents. And all documents and forms should be consistent once they are created. Such a feature would save a lot of time to nurses.

  2. A timeline with user-friendly reminders. Nurses will be happy to see a list of documents that should be created and sent to CMS day to day. It will help them to meet deadlines that are really important for the facility owners who want to be paid.

  3. Automatic batch submission to the centers of Medicare and Medicaid. This third feature will complete the procedure and make it valuable.

We envision these three features as a whole workflow that forms an appropriate medical project. The mentioned features along with an EMR module can have marketing names and be promoted as selling points.


Some healthcare software developers do not like to deal with CMS standards as messing with fields and consistency rules is boring and time consuming work. But I personally have always thought that it is worth the effort because of the amazing result.

The feedback I was getting from nurses was so excellent! I hope you have imagined the huge amount of work they have to do. Now imagine that this amount of work has turned literally into a few clicks. Well, sometimes they do have to enter big chunks of information into the medical automation system, but only in well-grounded situations. The hassle is removed completely.

So, they appreciated my work like I saved their lives. Such a feedback always motivates engineers, you know.


Similar healthcare software development projects are always hot because so are over-engineered medical standards. Drop me a few lines on the Contact Us page if you have a question about CMS standards automation. Or, probably, you want to develop your own medical software? If you do, we would be happy to participate in it because there are so many exciting CMS standards we have not automated yet.

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