Understanding the BIMS Score: Facility Guide and FAQ

All long-term care (LTC) facilities are responsible for meeting federal regulations set by the Centers for Medicare and Medicaid Services (CMS). As part of this commitment, LTC providers are required to conduct a Brief Interview for Mental Status (BIMS) assessment, to screen and monitor the cognitive functioning of each resident who is admitted into their facility. BIMS scores must then be documented and reported to maintain federal regulatory compliance.

If you’re an LTC facility leader, you likely want to ensure that your staff are accurately conducting and documenting the BIMS cognitive test to meet the highest standards of care. Here you’ll find answers to key questions about the cognitive tool’s administration process, alongside guidance on how to document BIMS scoring results in accordance with CMS requirements.

Using this guide, you’ll be better equipped to ensure compliance without question, navigating this mandatory testing process with confidence.

What Is the Purpose of the BIMS Test?

The Brief Interview for Mental Status is a standardized assessment tool that’s used to screen the cognitive functioning of residents in LTC facilities. Similar to the SLUMS assessment, this tool was created to help providers minimize the risk of incorrectly diagnosing cognitive impairment, but should not be used as an actual diagnostic tool. BIMS scores are instead meant to help providers detect early symptoms of dementia, track changes in a resident’s cognition over time, and inform the need for further evaluation.

The test is a required part of CMS’s Minimum Data Set (MDS) reporting, which impacts how LTC facilities are reimbursed. If BIMS assessments are documented incorrectly, facilities may face financial losses while putting their residents at risk for worsened health outcomes.

How Do You Explain the BIMS Assessment to Patients?

Before diving straight into testing, it’s important for clinicians to sit down with patients and explain how the exam will be conducted. Be sure to cater your teaching to meet each patient’s cognitive level.

For example, if a patient is disoriented or confused at the time of testing, you can keep the teaching simple and mention that you’re there to ask a few simple questions. If a patient is alert and cognitively intact, you can go into a bit more depth about why you’re conducting the exam and review the types of questions you’ll ask. When explaining how the test will be conducted, you’ll want to speak in a warm, comforting tone, as this may be a patient’s first ever cognitive exam.

Some patients may be worried about how they’ll perform on the exam and could fear a loss of independence or quality of life depending on their BIMS score. It’s important for the administering clinician to provide sensitivity and comfort to patients and family members, letting them know they’ll be supported throughout the entire process.

Additionally, patients and family members may have questions about the scoring of the exam and could be curious to know what scores may require additional testing or intervention. Generally, if a patient scores between 13 and 15, no additional testing is required. If a patient scores between 0 and 12, additional follow-up screenings and assessments may be completed to develop a care plan that adequately addresses the patient’s unique needs.

What’s on the BIMS Test for Dementia?

The BIMS tool is divided into three key sections. These include:

1.Repetition of Three Words

This section evaluates a resident’s attention. The resident is asked to recite three simple words (sock, blue, and bed are commonly used examples) and they’re assessed based on how many words they’re able to repeat back.

2. Temporal Orientation

This section assesses a resident’s orientation. The resident is asked to report the year, month, and day of the week, respectively. They’re evaluated based on how accurately they report each one.

3. Recall

This section evaluates a resident’s ability to recall past information. They’re asked to repeat the three words from the first part of the assessment and assessed based on their ability to remember and recite each word.

The questions under each section are scored using different scales. The complete list of questions and their respective rating scales can be found on the full BIMS assessment tool.

How Is the Test Administered?

This test is designed to be administered by a healthcare provider (most commonly a social worker or a nurse) during admission and regularly throughout a resident’s stay. To administer the test, the provider sits down with a resident and asks them the questions listed under each section of the tool. The provider then uses a BIMS score chart to check off the appropriate rating for each question based on the resident’s responses. Facilities are encouraged to utilize CMS’s official instructional video on BIMS when training staff on administration.

BIMS Score Calculator: Method and Example

BIMS scoring works by adding up the number ratings corresponding to how a resident answers each of the BIMS test questions. To provide a more detailed example, we’ll walk through a hypothetical assessment below.

Section 1: Repetition of Words

The nurse asks a resident to repeat the words sock, blue, and bed. The resident is able to repeat sock and blue but not the word bed. Since they’re able to recall two words, the nurse assigns two points for this section (out of a possible total of three).

Section 2: Temporal Orientation

The nurse asks the resident to recite the year, month, and day of the week. At the time of the assessment, it is Wednesday, July 17, 2025. The resident states that it is a Wednesday in June of 2025, correctly identifying the year and day of the week, but incorrectly identifying the month. Based on this response, the nurse scores this section as follows:

Adding up the ratings above, the nurse assigns five points total for this section.

Section 3: Repetition of Words

The nurse asks the resident to think back to the first question of the assessment and recite the three words that they were originally asked to repeat. The resident is able to recall sock, but can’t remember the remaining two words off the top of their head. The nurse follows up by reminding the resident that the second word is a color and the third word is a piece of furniture. From these clues, the resident is able to recall the word blue, but still can’t remember the word bed. The nurse scores this section as follows:

Adding up the ratings above, the nurse assigns three points total for this section.

BIMS Score Meaning

Adding up the points in each of the sections above, the nurse calculates a score of 10 for this resident. Total scores on the BIMS can range from 0 to 15 points, and the following score ranges are used to determine the severity of cognitive impairment:

• 0 to 7: Severe cognitive impairment
• 8 to 12: Moderate cognitive impairment
• 13 to 15: Cognition is intact

Since the resident’s total score falls between 8 and 12, the care team can infer that this resident may have moderate cognitive impairment.

BIMS Score Interpretation

When interpreting scores, keep in mind that BIMS should not be used as a diagnostic tool. If the resident’s score decreases over time, this can indicate that their mental abilities are declining. A very sudden and drastic drop in scores can also indicate potential delirium. In these situations, the overseeing physician may take additional measures to evaluate the resident and implement interventions as necessary.

It’s also important to consider other factors that could impact a resident’s ability to complete this assessment. For example, hearing or communication impairments can make it more difficult for a resident to repeat the words in the first part of the assessment. As such, providers should holistically consider a resident’s medical history and health status when using the tool to inform their plan of care.

Once the clinician administering the exam has appropriately interpreted the patient’s BIMS assessment score, it’s important that they accurately document the results in the patient’s electronic health record. Be sure to explain the results to the patient and any family members present and provide insight into the timing of any follow-up testing, if required.

How Do Facilities Report BIMS Results to CMS?

BIMS testing is a part of MDS reporting requirements, so assessments must be documented and transmitted to CMS electronically via the iQIES portal. It’s important to accurately document scores for each resident to receive full reimbursements from CMS. More information about MDS reporting can be found on CMS’s website.

Learn More Ways to Improve Care and Maintain Compliance

As a facility leader, staying on top of federal regulations (like mandatory BIMS score reporting) can feel overwhelming, but it doesn’t have to be. Use our expert-written healthcare management tips and insights to stay updated on the latest compliance standards and best practices.