North Carolina Medicaid Trends Continue

In every state we analyze that has a case-mix system there are certain trends that we see over and over. Two of the most common trends are:

  • Average case-mix slowly increases over time. This is true even in states that have a budget neutrality factor (BNF). North Carolina doesn’t have a BNF. In states that do have a BNF, it really is true that if your case-mix isn’t increasing, your reimbursement will decline slowly over time.

  • The percentage of residents with a therapy RUG slowly increases over time. You can almost tell how long a state has been on case-mix by the percentage of rehab RUG days. This is true even in states that don’t use a “point in time” or “picture” date.

Let’s check out the latest quarterly data from the state of North Carolina.


Case-mix continues its slow, unsteady climb upward. This isn’t surprising or new. The magnitude of the uptick is high, but not unprecedented.


The same general trend appears here. Therapy is driving case-mix higher over time. If you are a long time reader of this blog this might look like a re-post. The “Therapy is driving case-mix higher” trend continues.


Providers continue to lose ground and under-code here. Even providers that understand ADL coding and how important it is, struggle to get accurate coding consistently over time.

Key Points

  • Accurate, consistent ADL coding is hard. That’s why Broad River Rehab spends so much time and effort on ADL training. (Seriously, we have: mobile training software, we do on-site, all-shift training sessions, we have training videos for our customers to use and we even put our own CNAs in facilities to code ADL activity that occurs during the delivery of therapy.) If you are in a case-mix state, Section G is important and isn’t going anywhere anytime soon, even while you focus on PDPM.

  • Speaking of PDPM, the next several quarters of data are going to be interesting. Will providers let ADLs slip further as they adjust to PDPM? Will we see a larger than normal increase in rehab days for Medicaid? Stay tuned. These are interesting times.

If you want to analyze your ADL scoring performance or talk about ways to improve your documentation compliance AND case-mix, contact us!