SNF QRP and SNF VBP Claims-Based Measure Manual and Accompanying Files – Available

This document presents technical specifications for the production of Medicare fee-for-service (FFS) claims-based measures (CBMs) for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) and Value-Based Purchasing (VBP) program maintained by the Centers for Medicare & Medicaid Services (CMS). The measures are intended to promote informed decisions among Medicare …

FY 2025 SNF VBP Program December 2023 Quarterly Reports

The December 2023 Quarterly Confidential Feedback Reports for the fiscal year (FY) 2025 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program are now available to download via the Internet Quality Improvement and Evaluation System (iQIES). These reports contain facility and stay-level data and results for the SNF 30-Day All-Cause Readmission …

Fall 2023 Unified Regulatory Agenda for CMS and Other HHS Agencies

Some items of potential interest: HHS/FDA Proposed Rule Stage Medical Devices; General and Plastic Surgery Devices; Classification of Certain Solid Wound Dressings, Wound Dressings Formulated as a Gel, Cream, or Ointment, and Liquid Wound Washes 0910-AI26 HHS/OIG Proposed Rule Stage Health Care Programs: Fraud and Abuse; Revisions to the Office …

CMS: Upcoming SNF QRP Measure Removals

The Centers for Medicare & Medicaid Services (CMS) is alerting Skilled Nursing Facility (SNF) providers of upcoming measure removals from the SNF Quality Reporting Program (QRP). The following quality measures are planned for removal from the iQIES Review and Correct Reports, Facility-Level Quality Measure (QM) Reports, and Resident-Level QM Reports …

Medicare Expedited Determination vs. Financial Liability Notices: What’s the Difference?

Beneficiary notification requirements under the Medicare program can be confusing for nurse assessment coordinators (NACs) who serve as the lead Medicare nurse and other interdisciplinary team members in skilled nursing facilities (SNFs), says Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC, director of education for Hansen, Hunter & Co. PC …

How to Explain the Nurse Assessment Coordinator Role to Others

The role of the nurse assessment coordinator (NAC) can often be an enigma to many nursing home staff. Misunderstandings about the position abound, and NACs may find it frustrating that no one knows what they do or its true impact. One of the most common misunderstandings about the NAC’s role …

MDS Items Impacting Reimbursement for PDPM and SNF QRP – Updated Tool

Do you know what MDS items impact reimbursement under the Patient-Driven Payment Model (PDPM) or the Skilled Nursing Facility Quality Reporting Program (SNF QRP)? Use this quick guide, MDS Items Impacting Reimbursement for PDPM and SNF QRP, for easy reference to get your payment straight. This AAPACN resource is copyright …

TIP: CMS Announced Updated MDS Specifications File

The Centers for Medicare & Medicaid Services (CMS) recently released the MDS Data Specifications V3.01.1 (FINAL) Errata, which updated the previous MDS Data Specifications file. CMS addressed six additional issues that will be implemented on Dec. 12, 2023, but will be retroactive to Oct. 1, 2023. Any modifications to assessments …

Sections K and O Assessment Periods

Effective Oct. 1, 2023, the Centers for Medicare & Medicaid Services (CMS) added columns for MDS items K0520 and O0110 to assess services provided “on admission” and “at discharge.” This change results in different assessment periods for these items depending on the assessment type(s). AAPACN’s Sections K and O Assessment …

Q&A: A new wound specialist disagrees with a wound that was previously coded as a Stage 3 pressure ulcer by the physical therapist and physician. Should I do a modification of the MDS to remove the Stage 3 pressure ulcer? 

Question: A wound certified physical therapist staged a sore as a Stage 3 pressure ulcer. This was also verified with the physician and coded on the last MDS assessment. We have a new wound specialist who states this wound should not have been a Stage 3 pressure ulcer. Should I …