On the surface, keeping Medicare-required MDS assessments on track appears to be one of the easier components of the PPS process. However, “in practice, it is a struggle everywhere for a number of reasons, including how quickly many residents come into and depart from facilities,” says Carol Maher, RN-BC, RAC-CT, director of clinical reimbursement at Ensign Facility Services, Inc., in Mission Viejo, CA.