About

The Brief Interview for Mental Status (BIMS) is the cognitive screening instrument embedded in Section C of the CMS Minimum Data Set 3.0. It produces a composite score from 0 to 13 by summing three domains: repetition of three words (items C0200A - C0200C, 0 - 6 points), temporal orientation across five elements (items C0300A - C0300E, 0 - 5 points), and word recall (items C0400A - C0400B, 0 - 2 points). A total score of 13 - 15 indicates intact cognition, 8 - 12 indicates moderate impairment, and 0 - 7 indicates severe impairment. Because the MDS 3.0 manual references a theoretical maximum of 15 in classification tables (accounting for earlier draft scoring), the functional maximum obtainable on the current BIMS is 13. A score of 13 maps to the intact range.

Errors in BIMS administration directly affect the resident's Care Area Assessment triggers, reimbursement classification under PDPM, and quality measure reporting. This calculator enforces the exact CMS scoring rubric so that transcription mistakes do not propagate into the MDS submission. Note: the BIMS is validated for use in long-term care and skilled nursing settings. It is not a diagnostic instrument for dementia and should not replace comprehensive neuropsychological evaluation.

Formulas

The BIMS total is a simple additive composite across the three cognitive domains:

BIMS = Repetition + Orientation + Recall

Where:

Repetition = C0200A + C0200B + C0200C (range 0 - 6)

Orientation = C0300A + C0300B + C0300C + C0300D + C0300E (range 0 - 5)

Recall = C0400A + C0400B (range 0 - 2)

Each repetition item C0200_i is scored: 2 = correct without cue, 1 = correct after cue, 0 = no attempt or incorrect after cue. Each orientation item C0300_j is binary: 1 = correct, 0 = incorrect or no answer. Recall item C0400A scores 1 if the resident can recall at least one word, 0 otherwise. C0400B scores 1 if the resident recalls all three words without cues, 0 otherwise.

Classification is then applied:

{

Intact cognition if BIMS ≥ 13Moderate impairment if 8 ≤ BIMS ≤ 12Severe impairment if BIMS ≤ 7

Reference Data

BIMS Domain	MDS Items	What Is Assessed	Points per Item	Domain Max
Repetition	C0200A - Sock	Immediate word registration	0, 1, or 2	6
	C0200B - Blue	Immediate word registration	0, 1, or 2
	C0200C - Bed	Immediate word registration	0, 1, or 2
Temporal Orientation	C0300A - Year	Knows current year	0 or 1	5
	C0300B - Month	Knows current month	0 or 1
	C0300C - Day of month	Knows day (within ±2)	0 or 1
	C0300D - Day of week	Knows weekday	0 or 1
	C0300E - Season	Knows current season	0 or 1
Recall	C0400A - Recall ability	Able to recall any words	0 or 1	2
	C0400B - Number recalled	Count of words recalled without cue	0 or 1	2
Total BIMS Score Range				0 - 13
Classification Thresholds (CMS)
Intact Cognition	Score 13 - 15			Low risk
Moderate Impairment	Score 8 - 12			Triggers CAA
Severe Impairment	Score 0 - 7			Triggers CAA

Frequently Asked Questions

Early drafts of the MDS 3.0 Section C included additional items that could yield up to 15 points. The final published instrument caps at 13. CMS retained the 13-15 classification band for backward compatibility and to account for potential future revisions. In practice, a score of 13 is the highest achievable and maps to the "intact cognition" category.

Under the Patient-Driven Payment Model (PDPM), the BIMS score feeds into the SLP (Speech-Language Pathology) and NTA (Non-Therapy Ancillary) components. A lower BIMS score (indicating more severe cognitive impairment) generally results in a higher case-mix index for these components, increasing the per diem rate. Incorrect scoring can therefore cause either underpayment or, if inflated, regulatory audit risk.

During administration, the assessor says three words (sock, blue, bed) and asks the resident to repeat them. If the resident repeats a word correctly on the first attempt, the score is 2. If the resident fails initially and the assessor provides a semantic or phonemic cue (e.g., 'it is something you wear on your foot') and the resident then says the word, the score is 1. If the resident cannot produce the word even after cueing, the score is 0.

If the resident is unable to communicate or refuses to participate in the interview, the BIMS cannot be completed. In this case, Section C of the MDS instructs the assessor to skip BIMS items and proceed to the Staff Assessment for Mental Status (items C0700 - C1000) as an alternative cognitive measure. This calculator does not cover the staff assessment pathway.

Yes. Per the RAI User's Manual, the resident's response for day of the month is scored as correct (1 point) if it falls within plus or minus 2 days of the actual date. For example, if the actual date is the 15th, answers of 13 through 17 are all scored as correct. All other orientation items (year, month, day of week, season) require an exact match.

Repetition (C0200) tests immediate registration - the resident repeats words right after hearing them. Recall (C0400) tests delayed memory - after the orientation questions create a time gap, the resident is asked to recall the three words. This delay typically spans 1-3 minutes. The recall section uses a different scoring scale: C0400A asks whether recall was possible at all (binary), and C0400B asks how many words were recalled without cueing.