The Early Look Performance Score Reports for the FY 2026 SNF VBP Program are now available for download via the Internet Quality Improvement and Evaluation System (iQIES). Beginning in the FY 2026 Program year, the SNF VBP Program is expanding to assess performance on multiple quality measures rather than a single measure. …
Question: Recently, I found two assessments that had a dementia diagnosis that does not map to a PDPM category, including F01.C2 for vascular dementia. How do I update these codes? Answer from Jeff Taylor:There are two parts to this. The first is that the available codes for dementia were updated to …
The Centers for Medicare & Medicaid Services (CMS) announced corrections to the Patient-Driven Payment Model (PDPM) mapping files for I0020B, the primary diagnosis representing the reason for the skilled nursing home stay, which is also used to determine a resident’s clinical category assignment under PDPM. CMS released an update to …
The “PDPM Grouper JAR Package V2.2002.zip” is now available. This release was updated to support corrections to the Fiscal Year (FY) 2024 Patient Driven Payment Model (PDPM) International Classification of Diseases (ICD)-10 code mapping for the purposes of resident classification under the PDPM for Medicare Part A Skilled Nursing Facility …
From https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf/list-federal-regulations/cms-1779-f2 Note: Typically, this file is posted at https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf/patient-driven-model
The Microsoft Access database containing the International Classification of Diseases (ICD)-10 codes allowed for item I0020B has been updated to reflect changes occurring soon with PDPM V2.2002. The new tables added should be treated as retroactive for FY2024. Please review the README.TXT included in the ZIP file From https://www.cms.gov/medicare/quality/nursing-home-improvement/minimum-data-set-technical-information
See the section “Enhance Enrollees’ Rights to Appeal a Medicare Advantage Plan’s Decision to Terminate Coverage for Non-Hospital Provider Services” for details on expedited determination changes for Medicare Advantage residents. Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F) On April 4, 2024, the Centers for Medicare & …
In the March 28, 2024 Fiscal Year (FY) 2025 Skilled Nursing Facility Prospective Payment System (SNF PPS) proposed rule, the Centers for Medicare & Medicaid Services (CMS) doesn’t propose the dizzying number of changes that ended up in the FY 2024 SNF PPS final rule. However, nurse assessment coordinators (NACs) …
The Centers for Medicare & Medicaid Services (CMS) issued a final rule that clarified Medicare Advantage (MA) coverage criteria for basic benefits, use of prior authorization, and the annual review of utilization management tools. While these changes became effective Jan. 1, 2024, CMS recently released a frequently asked questions document …
