Since the implementation of the Patient-Driven Payment Model (PDPM), nursing facilities have had to take a more nuanced approach to how a resident’s needs are assessed and documented. As discussed in part 1 of this series, Medicare payment, as well as Medicaid payment in many states, is determined using PDPM …
From https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing From https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing/confidential-feedback-reporting-review-and-corrections From https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing/scoring-methodology-payment-adjustment
CDC announces new ICD-10-CM codes effective October 1, 2025. The October 1, 2025 diagnosis code update files are now available. Use these files for discharges occurring from October 1, 2025 – September 30, 2026, and for patient encounters occurring from October 1, 2025 -September 30, 2026. The files in the 2026 …
The Centers for Medicare & Medicaid Services (CMS) did not propose any changes to the previously adopted quality measure (QM) sets for either the Skilled Nursing Facility Quality Reporting Program (SNF QRP) or the Skilled Nursing Facility Value-Based Purchasing program (SNF VBP) in the Medicare Skilled Nursing Facility Prospective Payment …
Regulation No. CMS-1827-F Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026; Final Rule Year 2026 Publication Date 2025-08-04 This rule (CMS-1827-F) is currently on public display at the Federal Register and will publish on August 4, …
On July 31, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a final rule for updates to Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year (FY) 2026. CMS is publishing this final rule in …
In skilled nursing facilities (SNFs), staff members often find the Patient-Driven Payment Model (PDPM) process complex and unfamiliar, especially when determining how Medicare (and, in many states, Medicaid) payment is calculated. PDPM is based on five separate case-mix adjusted components: Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP), …
Myers and Stauffer provides documentation resources and training opportunities for several state Medicaid programs. Learn more below. State Clients Alabama Iowa North Carolina Arkansas Kentucky Ohio California Louisiana Oregon Colorado Maryland Tennessee Connecticut Minnesota Texas Florida Mississippi Utah Georgia Missouri Vermont Hawaii Montana Wisconsin Idaho Nevada West Virginia Indiana New …
Question: A resident previously exhausted his 100 days of Medicare for a new feeding tube. He was discharged to an assisted living facility (ALF) for more than 60 days where an licensed practical nurse (LPN) assisted with the 100% tube feedings. Did this resident achieve a 60-day break in skilled …
The Centers for Disease Control and Prevention (CDC) recently released the updated codes for fiscal year (FY) 2026. These updates include the addition of the following locations to the category L98.4, non-pressure chronic ulcer of skin, not elsewhere classifiable: Additionally, a new category L98.A, will be added to include non-pressure …
