Medicare & Medicaid Standards Automation - an Idea That Works

There is a popular idea among all healthcare software development 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.

An effective CMS automation software should solve the aforementioned issues by incorporating the following functionalities:

  1. Automated form filling: While entering initial data of a new client is essential, a good software should allow for pre-filling of subsequent forms and documents using the previously entered data. This feature can also be extended to fill out new documents using the information from earlier forms, thereby ensuring consistency across all documents. Such automation would save a significant amount of time for nurses.

  2. User-friendly timeline with reminders: Nurses would greatly benefit from a timeline that lists the documents that need to be created and submitted to CMS on a daily basis. This feature would help them meet crucial deadlines and ensure timely payment for the facility owners.

  3. Batch submission to Medicare and Medicaid centers: The final and crucial feature of a CMS automation software is the automatic batch submission of all documents to the relevant Medicare and Medicaid centers, completing the procedure and adding value to the software.

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 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 healthcare 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.