MANUAL v1.20.1 · 2025-10-01MATRIX v1.20.1v4 · 2025-10-01
Z

Section Z: Assessment Administration

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Z0100

Medicare Part A Billing

Item Rationale

Manual page Z-1Z0100A

Medicare Part A: HIPPS code

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0100B

Medicare Part A: Version code

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0200

State Medicaid Billing (if required by the state)

Item Rationale

2 governed answer/subitem rowsZ0200A

State Medicaid Billing: Case Mix group

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0200B

State Medicaid Billing: Version code

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0250

Alternate State Medicaid Billing (if required by the state)

Item Rationale

Manual page Z-3Z0250A

Alt State Medicaid Billing: Case Mix group

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0250B

Alt State Medicaid Billing: Version Code

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0300

Insurance Billing

Item Rationale

Manual page Z-4Z0300A

Insurance Billing: Billing Code

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0300B

Insurance Billing: Billing Version

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0400

Signatures of Persons Completing the Assessment or Entry/Death Reporting

Entry/Death Reporting (cont.)

Manual page Z-7Z0400A

Attestation signature, title, sections, date

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0400B

Attestation signature, title, sections, date

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0400C

Attestation signature, title, sections, date

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0400D

Attestation signature, title, sections, date

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0400E

Attestation signature, title, sections, date

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0400F

Attestation signature, title, sections, date

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0400G

Attestation signature, title, sections, date

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0400H

Attestation signature, title, sections, date

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0400I

Attestation signature, title, sections, date

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0400J

Attestation signature, title, sections, date

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0400K

Attestation signature, title, sections, date

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0400L

Attestation signature, title, sections, date

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0500

Signature of RN Assessment Coordinator Verifying

Assessment Completion (cont.)

Manual page Z-8Z0500A

Signature of RN assessment coordinator

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20Z0500B

Date RN signed assessment as complete

This item is referenced against CMS MDS source materials. Verify coding against the current CMS RAI Manual, item set instructions, and facility documentation before submission.

MDS Item Matrix page 20