Billing and Reimbursement
AAPACN’s billing and reimbursement resources include articles, tips, and tools to keep post-acute care leaders informed of changes and to ensure facility success under various payment models.
- Becoming a Fiscally Savvy DNS – Part 2: Budget, Revenue, and Five-Star RatingsWhen one considers financial management, thoughts usually go to managing expenses first, which part one of this series discussed. However, managing revenue, Five-Star ratings, and the budgeting process are equally important to keeping the nursing department and …
- CASPER Reporting User’s Guide for MDS Providers UPDATED (5/22)The CASPER Reporting User’s Guide for MDS Providers provides information and instructions pertaining to the CASPER Reporting application. This system enables users to connect electronically to the National Reporting Database. This guide is intended for …
- Updated MDS Item Set Proposed for FY 2024The last MDS item set update nurse assessment coordinators (NACs) had to prepare for was v1.17.1. When it went into effect Oct. 1, 2019, that version provided the changes needed to implement the Patient-Driven Payment …
- TIP: Don’t Use ICD-10-CM Code as Primary with “Disease Classified Elsewhere” or “Code First” InstructionsWhen determining the primary diagnosis for a resident, the coder must consider the guidance set forth in the ICD-10-CM Official Guidelines for Coding and Reporting for each fiscal year. One area that may cause confusion …
- 3 Things NACs Need to Know about the FY 2023 SNF PPS Proposed RuleIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN, and Jessie McGill, RN, RAC-MT, RAC-MTA, curriculum development specialist for AAPACN, discuss the recently released …
- Q&A: Does an inpatient rehab stay count toward a qualifying hospital stay for Medicare coverage?Question: We have a referral for a resident with Medicare Part A who has been in an inpatient rehab facility (IRF) for six weeks. Is the IRF still considered acute and can qualify for the …
- Q&A: A Medicare Part A resident was admitted to the hospital and returned to the SNF for a new Medicare stay. Does the diagnosis from the original stay need to be used or can this change?Question: A resident was Medicare Part A with a primary diagnosis of pneumonia. On day 15 of the stay, the resident was admitted to the hospital for five days for atrial fibrillation and hospital acquired …
- Q&A: How many days can a Medicare Part A resident be out on a therapeutic leave and be able to come back to the facility without it being considered an End of Stay?Question: How many days can a Medicare Part A resident be out on a therapeutic leave and be able to come back to the facility without it being considered an End of Stay? Answered by …
- TIP: CMS Asking for Comments on New SNF PPS Proposed RuleThe Centers for Medicare & Medicaid Services (CMS) released the Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) Proposed Rule earlier this month. CMS notes that this proposed rule would update “Payment …
- PDPM: Clearing Up Nursing Component Confusion – Part 5 – Behavioral Symptoms and Cognitive Performance and Reduced Physical FunctionEditor’s note: This is the fifth and final article in a series on the Patient Driven Payment Model (PDPM) categories for the nursing component, covering various missteps to avoid in PDPM calculation, as well as …
- Q&A: How are therapy services billed when a resident is admitted to the facility for skilled nursing only and hospital documentation recommended outpatient services at home for PT/OT?Question: We have a patient coming to us that the hospital rehab documented they are not appropriate for skilled rehab and recommended home with PT/OT outpatient. However, the physician documented a skilled nursing need to …
- Resident Cognitive Level Determination: For the SLP and Nursing Components Under PDPMIf the BIMS interview is not completed, the PDPM Cognitive Level will be used to determine cognitive impairment under the SLP and Nursing components of PDPM. AAPACN has updated its Resident Cognitive Level Determination Tool to help nurse …
- CMS Nursing Home Data Sets Updated (4/22)Five-Star, NHQI, SNF QRP, SNF VBP, and PBJ data Provider Information General information on currently active nursing homes, including number of certified beds, quality measure scores, staffing and other information used in the Five-Star Rating …
- Highlights from CMS’s 2022 Updates AAPACN Conference SessionLast week, the AAPACN 2022 Conference was held in Las Vegas, bringing together nursing professionals for exceptional learning opportunities. One outstanding session occurred on Thursday, April 14, when representatives from the Centers for Medicare & …
- New Measures and New Rules Will Change the SNF VBP LandscapeWith the release of the Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) proposed rule, the Centers for Medicare & Medicaid Services (CMS) has signaled a significant commitment to pay-for-performance via …
- FY 2023 SNF PPS Proposed Rule Pushes SNFs Out of Emergency ModeWhile the COVID-19 public health emergency (PHE) put the brakes on many nursing home initiatives over the past two years, the Centers for Medicare & Medicaid Services (CMS) is ready to get back to business …
- SNF VBP: FY 2026 Program Year Proposed Nurse Staffing Measure Technical Specifications (4/22)Proposed Specifications for the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program: Total Nursing Hours per Resident Day Measure (PDF) From https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/SNF-VBP/Measure
- Meeting SNF QRP HCP COVID-19 Vaccine Data Submission Requirements? Find Out With This Update to SNF Provider Threshold Report (4/22)An updated version of the Skilled Nursing Facility (SNF) Provider Threshold Report (PTR) is now available. The PTR is a user-requested, on demand report which enables users to obtain the status of their data submission …
- COVID-19 Emergency Declaration Blanket Waivers List Updated (4/22)You can read the blanket waivers for COVID-19 in the List of Blanket Waivers (PDF) UPDATED (4/7/2022). From https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page
- FY 2023 SNF PPS Proposed Rule Is Posted: Link, Press Release, and Fact Sheet (4/22)Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Quality Reporting Program and Value-Based Purchasing Program; Long-Term Care Facilities to Establish Mandatory Minimum Staffing Levels https://www.federalregister.gov/public-inspection/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities Press release:HHS Takes Actions to Promote …
- SNF Q4FY21 PEPPER Available (4/22)The Q4FY21 release of the Skilled Nursing Facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through September 2021 is now available for download through the PEPPER Resources Portal. To obtain your SNF PEPPER, the Chief Executive Officer, President, Administrator, …
- Q&A: If a resident on a Medicare Part A stay goes on a leave of absence for two days, is it considered an interrupted stay? Question: We have a resident who is currently on Medicare Part A receiving skilled services for rehabilitation. His family would like to take him out for a leave of absence (LOA) from Thursday morning to …
- Q&A: When a resident is status-post surgery, would that be enough criteria to quality for skilled services?Question: When a resident is status-post surgery, would that be enough criteria to quality for skilled services? Answer from Jeff Taylor: It really depends on the resident’s condition and what services/cares they need. If the resident …
- FY 2023 SNF PPS Proposed Rule Preview: Report Indicates SNF VBP and SNF QRP Proposed Measures (4/22)CMS has released the following document addressing the SNF VBP and SNF QRP programs: 2022 MUC List Program-Specific Measure Needs and Priorities (PDF) SNF VBP “For the FY 2023 SNF PPS proposed rule, the SNF VBP will …
- SNF QRP Quick Reference Guide (4/22)An updated Quick Reference Guide is now available. The Quick Reference Guide provides high-level information on the SNF Quality Reporting Program, including frequently asked questions and helpful links. V2.0 was posted in early March. It …
- Definition and Uses of Health Insurance Prospective Payment System (HIPPS) Codes (4/22)CMS has updated the following document: Definition and Uses of HIPPS Codes (Updated 04/01/2022) (PDF) From https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes
- MedPAC March 2022 Report on Medicare Payment Policy (3/22)The Medicare Payment Advisory Commission (MedPAC) has released its March 2022 Report to the Congress: Medicare Payment Policy. The report includes MedPAC’s analyses of payment adequacy in traditional fee-for-service (FFS) Medicare and reviews the status of Medicare …
- PDPM: Clearing Up Nursing Component Confusion – Part 4 – Focus on Clinically ComplexEditor’s note: This is the fourth article in a series on the PDPM categories for the nursing component, covering various missteps to avoid in PDPM calculation, as well as essential coding tips. Part one focused …
- Accurate ICD-10 Coding Requires a Deeper DiveA nurse assessment coordinator (NAC) needs an ICD-10-CM diagnosis code for MDS section I (Active Diagnoses) or a Medicare claim. They enter the physician-documented, active diagnosis into a software tool or online lookup tool and …
- TIP: CMS Offers New PBJ Training and ResourcesCMS recently posted a one-page document that provides links to important Payroll-Based Journaling (PBJ) action items, including how to complete registration for staff, corporate, and third-party users, as well as data submission trainings and resources. …
- ICD-10 Diagnosis Coding for Skilled Nursing Facilities with Carol MaherIn this podcast, Amy Stewart, vice president of education and certification strategy for AAPACN, and Carol Maher, director of education for Hansen, Hunter & Co., discuss ICD-10 diagnosis coding for skilled nursing facilities.
- Frustrated by Managed Care Payment Denials? Learn to Spot Key LandminesMedicare Advantage (MA) plans, the most common type of Medicare managed care organizations, are an attractive option for healthy Medicare beneficiaries in the community because they often provide a range of supplemental benefits that aren’t …
- SNF PPS Web Pricer for FY 2020 – FY 2022 Available (3/22)The Skilled Nursing Facility (SNF) PPS Web Pricer is now available for Fiscal Years (FYs) 2020 through 2022. The new SNF Web Pricer can be accessed via the following link: https://webpricer.cms.gov/#/pricer/snf. For the best user experience, …
- SNF VBP Online Resources: FAQs Updated (3/22)CMS has an online home for the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program that offers multiple resources explaining how the program works. Landing page: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/SNF-VBP/SNF-VBP-Page.html Measure Scoring Methodology & Payment Adjustment Confidential Feedback …
- PDPM: Clearing Up Nursing Component Confusion – Part Three – Focus on Special Care LowEditor’s note: This is the third article in a series on the PDPM categories for the nursing component, covering various missteps to avoid in PDPM calculation, as well as essential coding tips. Part one focused …
- Solving the IPA Mystery Can Help NACs Show Their WorthThe nurse assessment coordinator (NAC) is still commonly stereotyped as a paper pusher or desk nurse in some sectors of long-term care, but the Patient-Driven Payment Model (PDPM) in the Skilled Nursing Facility Prospective Payment …
- Q&A: Some members of my PDPM team feel that the diagnosis R27.8 “Other lack of coordination” should be used as the primary diagnosis. What kind of documentation would you need to be able to use this code?Question: Some members of my PDPM team feel that the diagnosis R27.8 “Other lack of coordination” should be used as the primary diagnosis. What kind of documentation would you need to be able to use …
- COVID-19 Medicare FAQs Updated (2/22)These address issues related to SNF consolidated billing, telehealth, and other Medicare coverage and payment issues. Frequently Asked Questions to Assist Medicare Providers (PDF) UPDATED (2/28/22) Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction (PDF) (2/16/21) Frequently …
- FY 2022 ICD-10-CM Code Files and Official Coding Guidelines Effective April 1, 2022 – Sept. 30, 2022 Updated (2/22)New ICD-10-CM code for Post-COVID Conditions, following the 2019 Novel Coronavirus (COVID-19) Announcement New ICD- code-for-Post-COVID-Condition-April 2022 pdf icon[PDF – 86 KB] April 1, 2022 release of ICD-10-CM The 2022 ICD-10-CM codes are to be used …
- Evaluation of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents—Payment Reform Final Report (2/22)Latest Evaluation Report Two Pager: Final Annual Findings At-A-Glance Report (PDF) Final Annual Report (PDF) Appendices (PDF)
- jRAVEN Free MDS Software Updated to v1.8.1 (2/22)The Resident Assessment Validation and Entry System (jRAVEN) was developed by the Centers for Medicare & Medicaid Services (CMS). jRAVEN is a free Java based software application which provides an option for facilities to collect …
- The Substantial Impact of the PHQ-9Nearly two years into the COVID-19 public health emergency (PHE), nursing home staff continue to see its impact on all residents, not just those who have recovered from COVID-19. According to the CMS memorandum QSO-20-39-NH, CMS’s …
- FY 2022 SNF PPS Final Rule: Document Link, CMS Fact Sheet, and Updated Wage Index Files (1/22)January 2022 update to wage index files as noted below Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2022; …
- At-a-Glance QM, QRP, and VBP ToolWith so many Quality Measures originating from three different payment initiative programs, it’s a lot to keep track of. AAPACN’s At-a-Glance QM, QRP, and VBP tool organizes all of the measures for you. This tool has been …
- SNF QRP COVID-19 Public Reporting Tip Sheet, 2nd Edition (1/22)The purpose of the Second Edition Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Public Reporting Tip Sheet is to help providers understand CMS’ public reporting approach to the SNF QRP to account for CMS quality data …
- PDPM: Clearing Up Nursing Component Confusion: Part Two – Focus on Special Care HighEditor’s note: This is the second article in a series on the PDPM categories for the nursing component, covering various missteps to avoid in PDPM calculation, as well as essential coding tips. Part one focused …
- Section GG Process Flow Chart ToolThe functional assessment coded in section GG often brings with it many questions— Should therapy complete this section? What type of documentation is needed? Can I use nurse aide documentation? How do we determine usual …
- Q&A: If hospital documentation supports a diagnosis of hip fracture as the initial encounter, do I need to query the physician for the subsequent encounter diagnosis to be used in the SNF?Question: If a resident had a hospital stay for hip fracture repair, with no complications documented, and the hospital documentation supports a diagnosis of hip fracture as the initial encounter, do I need to query …
- Q&A: A resident was picked back up on Medicare Part A during the 30-day window for a new Medicare Part A stay. Can the drug regimen review from the prior stay be used to code section N?Question: We have a resident who admitted on Medicare Part A and a drug regimen review (DRR) was completed at that time. Skilled services ended a couple weeks later, and she remained in the facility …
- FY 2022 Final PDPM Grouper Updated (1/22)An updated version of the PDPM Grouper has been posted in the Downloads section below with the new version number V2.0003 and will be implemented into the MDS ASAP system on Friday February 4, 2022. …
- Q&A: If a mechanically altered diet is being trialed during a speech therapy visit to facilitate oral intake, could K0510C, mechanically altered diet, be coded on the MDS?Question: We are seeking clarification on MDS item K0510C, mechanically altered diet. If a resident is being trialed on a mechanically altered diet or given thickened liquids provided during a speech therapy visit to facilitate …
- Q&A: What is the requirement for physician certifications when a resident transitions from Managed care to Original Medicare Part A?Question: A resident admitted under a managed care plan on December 15, but disenrolled and went to Original Medicare as of January 1. What is the requirement for physician certifications? Answer: Restart Medicare physician certifications …
- PDPM At-a-Glance ToolThe PDPM At-a-Glance tool breaks down the complex methodology of each component used in the Patient-Drive Payment Model—physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), non-therapy ancillaries (NTA), and nursing. This tool provides key …
- Q&A: What are the changes affecting SNFs in the updated blanket waiver that was recently released?The COVID-19 Emergency Blanket Waivers for Health Care Providers that was updated and released on Nov 29, 2021 adds a new waiver that allows more flexibility in the education and training requirements for individuals serving …
- PDPM: Extensive Services Nursing Category SimplifiedEditor’s note: This is the first article in a series on the PDPM categories for the nursing component, covering missteps to avoid in PDPM calculation, as well as essential coding tips. Future articles will address …
- SNF VBP and SNF QRP MUC List Includes VBP Nursing Hours Measure (12/21)The annual Measures Under Consideration (MUC) List from CMS includes four SNF VBP measures and two SNF QRP measures. 2021 MUC List (PDF) from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Pre-Rulemaking See Appendix A for measure specifications. MUC ID Measure Title …
- 2022 SNF Consolidated Billing HCPCS Code File (12/21)Note that pre-2022 changes are included in this update. 2022 Part A MAC Update https://www.cms.gov/medicare/snf-consolidated-billing/2022-part-mac-update2022 Downloads 2022 Annual SNF Consolidated Billing HCPCS Updates (ZIP) General Explanation of the Major Categories for SNF CB (PDF) Part …
- Q&A: Where are SNF quality measure data publicly reported?Question: Where are SNF quality measure data publicly reported? Answer from CMS SNF QRP FAQs: The Care Compare website was launched in August 2020. It combines the Centers for Medicare & Medicaid Services (CMS) eight …
- Q&A: When a Medicare Part A resident discharges to another SNF and will continue skilled Medicare there, what assessments are required and what is the date used in A2400C?Question: I have a Medicare Part A resident discharging to another SNF and will continue skilled Medicare there. Would I combine the OBRA Discharge with a PPS Part A Discharge assessment? In A2400, would I …
- SNF PPS and Part B Therapy MedPAC Payment Basics Fact Sheets / Educational Tools (10/20)Nov 03, 2021 / PAYMENT BASICS: SNF PPS Skilled nursing facility services payment system Nov 03, 2021 / PAYMENT BASICS: Part B therapy Outpatient therapy services payment system Additional payment basics tools: https://www.medpac.gov/document-type/payment-basic/
- Part B Therapy (22x and 23x Bill Types): Reduced Payment re: PTAs and OTAs (11/21)Transmittal 10934, dated August 13, 2021, is being rescinded and replaced by Transmittal 11129, dated, November 18, 2021 to update the background/policy section. Also, this Transmittal is no longer sensitive and may now be posted …
- CMS Summary of CY 2022 Medicare Physician Fee Schedule Final Rule Policies (11/21)Transmittal # R11115CP Issue Date 2021-11-16 Subject Summary of Policies in the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT …
- How to Be Proactive in Approaching Part B Denials with Erin DuPraeIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN and Erin DuPrae, OTR/L, clinical support specialist with AAPACN Diamond Partner, Synchrony Rehab, discuss how …
- PDPM: Making the Speech Language Pathology (SLP) Component Easier to SwallowEditor’s note: this article was reviewed and revised December 2, 2021. Without a full understanding of how the SLP component of the Patient-Driven Payment Model (PDPM) is calculated, it can seem complicated. The SLP methodology …
- SNF QRP MDS Item GG0130 Assessment and Coding Job Aids (11/21)Job Aids – GG0130A. Eating, GG0130B. Oral Hygiene, GG0130C. Toileting Hygiene, GG0130E. Shower/Bathe Self, GG0130F. Upper Body Dressing, GG0130G. Lower Body Dressing, and GG0130H. Putting On/Taking Off Footwear The Centers for Medicare & Medicaid Services (CMS) …
- Calendar 2022 Part A Coinsurance and Part B Deductibles (11/21)Calendar Year 2022 Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts Permalink Calendar Year 2022 Part A Premiums for the Uninsured Aged and for Certain Disabled Individuals Who Have Exhausted Other Entitlement …
- 2022 Annual Update to the Therapy Code List (11/21)This Change Request (CR) updates the list of codes that sometimes or always describe therapy services. The additions, changes, and deletions to the therapy code list reflect those made in the Calendar Year (CY) 2022 …
- CY 2022 Medicare Physician Fee Schedule Final Rule — Part B News (11/21)Medicare Program: CY 2022 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; etc. On November 2, CMS is announcing actions that will advance …
- IPAs: Better Payment Can Drive Better Care DecisionsThe Interim Payment Assessment (IPA) in the Patient-Driven Payment Model (PDPM) of the Skilled Nursing Facility Prospective Payment System (SNF PPS) is completed solely at the discretion of the SNF—and so far, few providers have …
- Q&A: A resident just returned during the interruption window. What OBRA assessments and tracking records do I need?Question: A resident on a Medicare Part A stay went to the hospital on 10/19 and returned on 10/20. He was admitted to the acute. This is my first time with an interrupted stay. Do …
- Section GG Web-based Training Module UPDATED (10/21)The Centers for Medicare & Medicaid Services (CMS) is offering an updated web-based training series on the assessment and coding of Section GG. This training is intended for providers in the following post-acute care (PAC) settings: Home Health Agencies (HHAs), …
- Q&A: If therapists or therapy assistants are working as nurse aides, can these hours be included in PBJ?Question: I have a facility that is experiencing a surge of COVID positive patients and staff. Presently, a significant portion of their staff is out due to COVID-19 or isolation related to COVID exposure. Their in-house …
- FY 2024 (Calendar 2022) SNF QRP Data Collection and Final Submission Deadlines (10/21)An update to the Skilled Nursing Facility Quality Reporting Program (SNF QRP) Data Collection and Final Submission Deadlines for the Fiscal Year (FY) 2024 SNF QRP is available. This document has been updated to reflect …
- FY 2024 (Calendar 2022) SNF QRP Table: Required Reporting Elements to Meet the Minimum Threshold (10/21)SNF QRP Annual Update Table for Reporting Assessment-Based QM and Standardized Patient Assessment Data Elements An update to the Skilled Nursing Facility Quality Reporting Program (SNF QRP) Annual Payment Update (APU) Table for Reporting Assessment-Based …
- SNF QRP FAQs for FY 2022 (10/21)An update to the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Frequently Asked Questions (FAQs) document is now available. This document has been updated to reflect the finalized policies for the SNF QRP in …
- ADR Successful Outcomes with Part B Therapy AuditsIn nursing facilities, one of the primary regulatory requirements from Appendix PP of the State Operations Manual is that goods and services are provided to attain or maintain the highest practicable physical, mental, and psychosocial …
- Looking Ahead: FY 2022 SNF PPS Final Rule Offers NACs a Crystal BallThe Fiscal Year (FY) 2022 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule contains a number of finalized changes—from revised SNF PPS payment rates for FY 2022 to updates to the Skilled Nursing …
- NAC Preparation Guide for the Triple Check Meeting ToolGathering all of the necessary reports for the triple check meeting is a lot for nurse assessment coordinators (NACs) to keep track of. Use the AAPACN’s NAC Preparation Guide for the Triple Check Meeting to …
- Q&A: Can a resident meet the skilled level of care criteria with only speech therapy?Question: I have always been taught that you cannot skill a resident for only speech therapy. However, now I am being told a resident that is receiving speech therapy 5 days a week should be …
- Q&A: A resident was receiving a skilled level of care on a Medicaid stay prior to a 3-day qualifying hospital stay. Will he be able to qualify for Medicare when he returns to the SNF?Question: A long-term care resident admitted to the hospital and will return after a 3-day qualifying inpatient stay. Prior to discharge, the resident had Medicaid as a primary payer and was receiving skilled therapy five …
- FY 2022 PDPM ICD-10 Mappings File REVISED (9/27/21)Download the Zip file: FY 2022 PDPM ICD-10 Mappings (ZIP) (revision posted 09-27-2021) From https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/PDPM
- CMS Will Pay for COVID-19 Booster ShotsSep 24, 2021 Following the Food and Drug Administration’s (FDA) recent action that authorized a booster dose of the Pfizer COVID-19 vaccine for certain high-risk populations and a recommendation from the Centers for Disease Control …
- SNF QRP Reporting Exceptions Granted Due to Hurricane Ida (9/21)The Centers for Medicare & Medicaid Services (CMS) is granting exceptions under certain Medicare quality reporting and value-based purchasing programs located in areas affected by Hurricane Ida to assist you while you direct your resources …
- Q&A: Can I notify a resident representative of discharge from skilled services by phone?Question: Can I notify a resident representative of discharge from skilled services by phone? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: According to NOMNC Form Instructions: If the provider is personally unable …
- FY 2022 SNF PPS Final Rule Highlights with Jessie McGillIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, AAPACN vice president of education and certification strategy, and AAPACN curriculum development specialist, Jessie McGill, RN, RAC-MT, RAC-MTA, talk about the Skilled Nursing Facility …
- PDPM: Clearing Up NTA ConfusionAt first glance, the methodology of the non-therapy ancillary (NTA) component of the Patient-Driven Payment Model (PDPM) seems simple: code qualifying items on the MDS to achieve points. Yet while the purpose of the NTA …
- SNF HAI Measure Puts the Spotlight on Billing, Not Just Infection PreventionThe Skilled Nursing Facility Healthcare-Associated Infections (SNF HAI) Requiring Hospitalization measure is one of two new quality measures (QMs) that the Centers for Medicare & Medicaid Services (CMS) adopted into the Skilled Nursing Facility Quality …
- TIP: CMS Added Clarification to 3-Day Qualifying Hospital Stay WaiverOn Sept. 8, 2021, CMS released a revised Medicare FFS Response to the PHE on COVID-19 (SE20011), including clarifications regarding the 3-day qualifying hospital stay (QHS) waiver. The following excerpt is from page 13 of …
- SNF QRP Quick Facts ToolsTwo new Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) measures become effective Oct. 1, 2021—the COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP) and the Healthcare-Associated Infections (HAI) Requiring Hospitalization. AAPACN has put together the …
- Providers Can Apply for New COVID-19 Funding Starting on Sept. 29Combined application for American Rescue Plan rural funding and Provider Relief Fund Phase 4 will open on September 29 The Biden-Harris Administration announced today that the U.S. Department of Health and Human Services (HHS), through …
- FY 2022 ICD-10-CM Code Files and Official Coding Guidelines Effective Through March 31, 2022 (12/21)Note: In December 2021, the CDC announced that this update and coding guidelines are only effective through March 31, 2022. New files and guidelines go into effect April 1, 2022, and remain in effect through …
- COVID-19 MLN Matters Article SE20011 Update Highlights Need to Meet Part A Level-of-Care Requirements (9/21)The section “SNF Qualifying Hospital Stay (QHS) and Benefit Period Waivers” in MLN Matters Special Edition Article SE20011 Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) has been updated. The …
- MDS Validation Utility Tool (VUT) V3.6.0 – Effective 10/01/2021Release Notes The Validation Utility Tool (VUT) is a software utility that can be used to validate MDS 3.0 submission files in XML format. The tool enforces the edits that are mapped to the MDS …
- State PDPM Data Collection Map ToolAAPACN has surveyed state RAI Coordinators, automation coordinators, and other stakeholders in all fifty states to develop a map which provides important guidance on the status of states collecting Patient-Driven Payment Model (PDPM) billing codes …
- FY 2022 PDPM ICD-10 Code Lookup File for MDS Item I0020B (9/21)The lookup files containing the allowable ICD codes for item I0020B have been updated for FY2022, and is posted as a separate ZIP file. PDPM_ICD_Codes_for_I0020B_FY2022 (ZIP) From https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30TechnicalInformation
- Hurricane Ida Waivers re: Louisiana, Mississippi, New York, New Jersey (9/21)2021 Hurricane Ida Secretary Becerra used his authority in the Public Health Service Act to declare a public health emergency (PDF) (PHE) on August 30, 2021, giving us the flexibility to support our beneficiaries in Louisiana, effective …
- COVID–19 HCP Vaccination Measure Changes the SNF QRP APU EquationEffective with the fiscal year (FY) 2023 Skilled Nursing Facility Quality Reporting Program (SNF QRP), SNFs must fulfill two separate but equal reporting requirements to avoid a 2 percent reduction in their annual payment update …
- TIP: CMS Releases SNF QRP Data Collection and Final Submission Deadlines for FY 2023CMS recently released the Skilled Nursing Facility Quality Reporting Program Data Collection & Final Submission Deadlines for the FY 2023 SNF QRP table, which provides data collection time frames and final submission deadlines for the …
- Q&A: Is a physician note of the diagnosis enough to support coding the diagnosis in the medical record?Question: The physician listed avascular necrosis of the hip in a progress note but did not address this diagnosis in a treatment plan. The resident is receiving PRN pain medication for this, which has been …
- TIP: CMS Releases SNF QRP Data Elements for Reporting Assessment-Based QMsCMS recently released the Skilled Nursing Facility Quality Reporting Program (SNF QRP) Overview of Data Elements Used for Reporting Assessment-Based Quality Measures Affecting FY 2023 Annual Payment Update (APU) Determination file. This is a list …