Discharge Function Score: Don't Leave Points (and Dollars) on the Table

By Kristen Walden, MSN, RN, RAC-CT, Clinical Reimbursement Consultant

The Discharge Function Score measures how well your facility helps Medicare Part A residents regain independence by discharge. This measure is publicly reported on Care Compare, supporting the idea that a higher score reflects better quality of care to families, referral sources, and payers.

It is calculated from 10 Section GG items scored at admission and discharge. These GG items include eating, oral hygiene, toileting hygiene, roll left and right, lying to sitting, sit to stand, chair/bed and toilet transfers, walk 10 feet, walk 50 feet with two turns, and wheel 50 feet with two turns when walking items are not completed at the 5-day or discharge assessment.

The score is then risk-adjusted against resident-level factors including admission function score, age, prior functioning, primary medical condition, cognitive function, pressure ulcers, bowel and bladder incontinence, nutritional status, history of falls, surgery, and MDS Section I comorbidities.

Why It Matters

The Discharge Function Score measure simultaneously impacts your Five-Star rating (15 to 150 points), SNF QRP public reporting, and, beginning in FY 2027, your VBP incentive payments. It is no longer just a quality measure. It directly affects revenue.

What to Focus On

Train Staff on Accurate GG Coding

Train staff consistently on GG scoring definitions, including setup versus supervision and partial versus substantial assistance distinctions. If the resident requires the assistance of two helpers to complete the activity, code dependent.

Codes such as 88 (Not Attempted) trigger statistical imputation, where CMS models the score instead of using observed performance, often lowering your results. Every unattempted item is a missed opportunity.

Capture an Accurate Baseline

Complete the GG Functional Assessment within the first three days of the Medicare Part A stay to capture the resident's baseline performance before therapy begins.

Code prior functioning in Section GG accurately, reflecting the resident's status immediately before the acute event, since this establishes the baseline for expected improvement.

Promote Functional Improvement

Promote mobility and independence from day one with therapy goals tied directly to GG items.

Ensure therapy-to-nursing carryover so that functional gains achieved in therapy translate to consistent performance during daily care.

Maintain Interdisciplinary Consistency

Interdisciplinary consistency in GG coding is critical. Review GG at admission and discharge during IDT meetings to align therapy and nursing documentation, resolve discrepancies, verify accuracy, and support clear communication across the care team.

Optimize Discharge Coding

At discharge, all GG tasks should be trialed within the last three days of the Medicare Part A stay. The focus should be on residents performing tasks as independently and safely as possible, with final GG coding based on a collaborative review of discharge performance and comparison to admission scores to accurately reflect functional progress.

Review Your Results

Review your QRP Review and Correct Report quarterly. Flag every "NT" (Not Triggered) resident and investigate the reason to identify opportunities for improvement.

As the Discharge Function Score becomes increasingly tied to public reporting, Five-Star ratings, and value-based purchasing, facilities cannot afford to overlook opportunities for improvement. Accurate assessments and consistent documentation help ensure resident progress is reflected appropriately, supporting stronger outcomes and facility performance.