How to Use the BIMS Test: 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 BIMS test to screen and monitor the cognitive functioning of each resident who is admitted into their facility.
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. To help you enforce appropriate use of this assessment tool, we’ll go over what this test is, the administration and scoring process, and how to document BIMS scores in accordance with CMS requirements.
What Is the BIMS Test?
The Brief Interview for Mental Status (BIMS) test 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. Scores should instead be used to help providers detect early symptoms of dementia, track changes in a resident’s cognition over time, and inform the need for further evaluation.
BIMS 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.
What’s On the BIMS Tool?
The BIMS tool is divided into three key sections. These include:
- Repetition of Three Words: This section evaluates a resident’s attention. The resident is asked to recite the words “sock,” “blue,” and “bed,” and they’re assessed based on how many words they’re able to repeat back.
- 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.
- 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 (sock, blue, and bed) 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 BIMS 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 card 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.
How Do You Calculate a BIMS Score? Example
To calculate a BIMS score, providers add up the number ratings corresponding to how a resident answers each question. 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, 2024. The resident states that it is a Wednesday in June of 2024, 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:
|
|
|
|---|---|
| Identification of Year | 3 points (correct answer) |
| Identification of Month | 1 point (missed by 6 days to a month) |
| Identification of Day of the Week | 1 point (correct answer) |
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 cues, the resident is able to recall the word “blue,” but still can’t remember the word “bed.” The nurse scores this section as follows:
|
|
|
|---|---|
| Able to Recall “Sock” | 2 points (able to recall without a cue) |
| Able to Recall “Blue” | 1 point (able to recall with cue) |
| Able to Recall “Bed” | 0 point (could not recall) |
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 BIMS 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.
How Do Facilities Report BIMS Scores to CMS?
The BIMS test 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.
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