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.
- CMS Nursing Home Data Sets UpdatedFive-Star, NHQI, SNF QRP, SNF VBP, PBJ data Announcement: January 2023: Data have been refreshed for January 2023. Because of COVID-19 reporting exceptions, the claims-based measures were calculated excluding Q1 and Q2 2020. For additional …
- SNF Medicare Provider Enrollment, Change of Ownership, and Revalidation Procedures UpdatedThe CY 2023 PFS Final Rule contains provisions concerning Medicareprovider enrollment. These principally involve the following: (1) Moving skilled nursingfacilities (SNFs), various provider enrollment ownership changes, and certain other providersand suppliers into the “high” level …
- Q&A: How long can a COVID-19 positive resident who met the criteria of strict isolation be covered under Medicare Part A?Question: How long can a COVID-19 positive resident who met the criteria of strict isolation be covered under Medicare Part A? Answer from Janine Cortesa RN, BSN:Isolation is not a daily skilled need, so that …
- SNF QRP: Feb. 15 Is the Next Quarterly Reporting DeadlineLearn more here: https://www.cms.gov/files/document/snf-qrp-data-collection-and-final-submission-deadlines-fy-2024-snf-qrp.pdf
- April 1, 2023 Release of Revised ICD-10-CM Code Files and Coding Guidelines–UpdatedIn an effort to better enable the collection of health-related social needs (HRSNs), defined as individual-level, adverse social conditions that negatively impact a person’s health or healthcare, are significant risk factors associated with worse health …
- COVID-19 Vaccine: Percent of Patients/Residents Who Are Up-to-Date Draft Measure Specifications–SNF QRPJanuary 2023 The Improving Post-Acute Care Transformation Act of 2014 (IMPACT Act) requires the Secretary to specify resource use measures and other measures, on which post-acute care (PAC) providers are required to submit necessary data …
- Kepro BFCC QIO Users: Updated Notification Process for New AppealsStarting on January 17, 2023, post-acute facilities and Medicare health plans will no longer receive phone calls for appeal notifications (when a new appeal has been filed). Post-acute facilities and Medicare health plans will receive …
- COVID-19 Public Health Emergency (PHE) RenewalJan. 11, 2023: As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Xavier Becerra, Secretary of Health …
- SNF QRP COVID-19 Public Reporting Tip Sheet, Third EditionThe purpose of the Third Edition Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) COVID-19 Public Reporting (PR) Tip Sheet is to help providers understand CMS’ public reporting approach to the SNF QRP to account for CMS …
- Q&A: What is a reasonable amount of time to skill a resident on Medicare Part A for being COVID-19 positive?Question: What is a reasonable amount of time to skill a resident on Medicare Part A for being COVID-19 positive? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: I would refer you …
- 2023 SNF Consolidated Billing HCPCS Code FileMajor Category II. A. – Dialysis, EPO, Aranesp, Other Related Services for ESRD ADD Major Category III. A. -Chemotherapy ADD Major Category III. C. -Radioisotopes and their Administration ADD Major Category IV. A. – Mammography …
- 2022 Medicare Fee-for-Service Supplemental Improper Data Report: SNFs No. 1 on Insufficient DocumentationSNFs were the provider type with the highest level of insufficient documentation, leading to an improper payment rate of 15.1 percent for the 2022 report period: https://www.cms.gov/files/document/2022-medicare-fee-service-supplemental-improper-payment-data.pdf
- NHSN Healthcare Personnel Safety (HPS) Component Website for SNF QRP HCP Influenza ReportingThe HCP Influenza Vaccination module in the HPS component of the NHSN is where SNFs enter data for the SNF QRP’s HCP Influenza Vaccination measure. This website offers access to training slides and other educational …
- CMS Confirms Customized Prosthetics SNF Consolidated Billing Exclusion re: Pre-Discharge Delivery of DMEPOS for Fitting and TrainingThis CMS transmittal adds the following note to CMS policy and billing procedures regarding the circumstances under which a supplier may deliver durable medical equipment, prosthetics, and orthotics – but not supplies – to a …
- SNF QRP and SNF VBP Measures Under Consideration (MUC) List UpdatedNote that CMS is planning a substantial revision to the adopted but still not implemented SNFPPR measure (SNF VBP) as well as to COVID-19 HCP Vaccination measure (SNF QRP). MUC2022-084* SNF QRP COVID-19 Vaccination Coverage …
- FY 2024 SNF VBP Program December 2022 Quarterly Reports Are Now AvailableThe December 2022 Quarterly Confidential Feedback Reports for the fiscal year (FY) 2024 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program are now available to download via the Quality Improvement and Evaluation System (QIES)/Certification and …
- TIP: Quality Improvement Organization Offers Training LibraryFor nursing facilities in 29 states, Kepro serves as the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). Kepro provides education for healthcare providers to help ensure that appeals are performed quickly and that potential errors …
- Q&A: We have a resident that is in our facility for skilled services under Medicare Part A. The family took the resident out for a funeral, and she did not return within 24 hours. Is this a Medicare Part A discharge?Question: We have a resident that is in our facility for skilled services under Medicare Part A. The family took the resident out for a funeral, and she did not return within 24 hours. Is …
- 2023 Annual Update of Part B Therapy Per-Beneficiary Threshold Amounts (11/22)The purpose of this Change Request (CR) is to update the annual per beneficiary incurred expenses amounts now called the KX modifier thresholds and related policy for calendar year 2023. These amounts were previously associated …
- MLN Web-Based Training: ICD-10 Diagnosis Coding (11/22)Learn to identify ICD-10-CM structure and format, recognize features, and find codes. Diagnosis Coding: Using the ICD-10-CM (October 2022) (Contact Hours 64 min.)
- Beneficiary Notice Guidelines ToolAre you confused about which beneficiary notices are needed and when? The Beneficiary Notice Guidelines tool lists scenarios that you might run into, clarifying exactly what notices are needed to reduce the risk of claim denials and …
- Skilled or Not? Tool – REVISEDUnderstanding the technical and skilled level care requirements for Medicare A is always a challenge. We’ve broken down the process with our Skilled or Not? tool. For permission to use or reproduce this article in full or …
- Calendar Year 2023 Medicare Physician Fee Schedule Final Rule Posted (11/22)On November 01, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates and policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or …
- SNF PPS Web Pricer for FY 2020 – FY 2023 Available (10/22)Update: End users have reported an issue with the Web Pricer applications, which renders it unable to produce estimates applicable to Fiscal Year 2023. CMS is currently working on this matter and will post an …
- Section GG Data Collection Tool for OBRA AssessmentsIs your state collecting PDPM data on OBRA assessments? Use AAPACN’s Section GG: Three-Day Performance Data-Collection Tool for OBRA Assessments to help guide your staff in documenting the resident’s performance during the window for each …
- IPA Algorithm ToolDo you and the interdisciplinary team know when an Interim Payment Assessment (IPA) is warranted? In AAPACN’s IPA Algorithm tool, find out the steps you’ll need to take in the event that there is a …
- Florida and Puerto Rico SNF QRP/SNF VBP Exception Memos (10./22)CMS addresses the SNF QRP and SNF VBP programs in affected areas: 2022-137-IP_FEMA Exception Memo Florida Hurricane Ian (PDF) FEMA Exception Memo Puerto Rico Hurricane Fiona_v5_CLEAN_(508) (1) (PDF) From https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-QR-Reconsideration-and-Exception-and-Extension
- COVID-19 Diagnosis Flow Chart for FY 2023The complexities of assigning codes for COVID-19 and associated manifestations can be a confusing process. The AAPACN COVID-19 Diagnosis Flow Chart tool uses chapter-specific coding guidance for FY 2023 and will assist the user to …
- Tips for Accurate ICD-10-CM Coding of COVID-19 InfectionOn October 13, 2022, the U.S. Department of Health and Human Services (HHS) renewed the COVID-19 public health emergency (PHE) determination for another 90 days. Although COVID-19 has been affecting skilled nursing facilities (SNFs) for …
- NHSN Healthcare Personnel (HCP ) Flu Vaccination Module (10/22)The HCP Flu Vaccination Module, which is part of the HCP component in NHSN, is used to input required NHSN data for the SNF QRP. This site provides access to the HCP Vaccination Module: Influenza …
- CMS Transmittals for Your Billers: PDPM Edit-Related Changes (10/22)Information on two transmittals is listed below: PDPM Reason Code 31849 Will Be Modified Enhancements to PDPM Claim Edits to Improve Claim Processing User Enhancement Change Request (UECR): Fiscal Intermediary Shared System (FISS) – Skilled …
- SNF PPS and Part B Therapy MedPAC Payment Basics Fact Sheets / Educational Tools (10/22)PAYMENT BASICS: SNF PPS Skilled nursing facility services payment system PAYMENT BASICS: Part B therapy Outpatient therapy services payment system Additional payment basics tools: https://www.medpac.gov/document-type/payment-basic/
- Proactive Steps for FYs 2023 – 2024 Center on Census and QualityOctober 1 is always an important date because it marks the transition to a new fiscal year for the fee-for-service Medicare Part A skilled nursing facility prospective payment system (SNF PPS). However, the next two …
- Payroll-Based Journal (PBJ) Audit ToolThe Centers for Medicare & Medicare Services (CMS) requires PBJ data to be submitted at least quarterly. It is imperative that this data is accurate as it is publicly reported and impacts the Five Star …
- COVID-19 Emergency Declaration Blanket Waivers List Updated (10/22)COVID-19 Emergency Declaration Blanket Waivers & Flexibilities for Health Care Providers (PDF) UPDATED (10/13/22) Unless otherwise noted, these waivers will terminate at the end of the COVID-19 public health emergency (PHE) From https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page
- CDC NHSN Influenza Vaccination Data Reporting for the 2022-2023 Influenza Season: Summary of Key Points for Nursing Homes (10/22)The CDC National Healthcare Safety Network (NHSN) Vaccination Unit provided a webinar for long-term Care (LTC) facilities on Tuesday, September 27, 2022 to review annual healthcare personnel influenza vaccination summary data reporting through the NHSN …
- FY 2023 ICD-10-CM Codes and Official Coding Guidelines Effective Oct. 1, 2022 (10/22)2023 release of ICD-10-CM The FY2023 ICD-10-CM codes are to be used from October 1, 2022 through September 30, 2023. Note: This replaces the FY 2022 – April 1, release. These files listed below represent …
- 2019 SNF Cost Report Data Released (10/22)The Skilled Nursing Facility (SNF) Cost Report dataset is a public use file that provides select measures from the skilled nursing facility annual cost report. This data includes provider information such as facility characteristics, utilization data, …
- PDPM FY2023: MDS Nurse FTE Calculator ToolAAPACN has re-released the MDS Nurse FTE Calculator for SNF leaders to estimate the time needed to complete assessments as well as project how many hours the NAC needs for meetings and other duties for fiscal …
- Working With Medicare Advantage Plans: 10 Tips to Maximize ResultsMedicare Advantage enrollment continues to grow, representing 48 percent of eligible Medicare beneficiaries in 2022, according to the Aug. 25, 2022, issue brief, Medicare Advantage in 2022: Enrollment Update and Key Trends, from the Kaiser …
- TIP: CMS Posts Several Updated SNF QRP DocumentsThe Centers for Medicare & Medicaid Services (CMS) recently posted updated versions of the following Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) documents: The Fiscal Year (FY) 2023 SNF QRP Frequently Asked Questions (FAQs) …
- Q&A: Is this an interrupted stay?Question: Is this an interrupted stay? A resident newly admits to the facility on 9/21 on a Medicare Part A stay. On 9/23, the resident was sent to the emergency room and was admitted to …
- Q&A: We have a resident for whom we are completing an Interim Payment Assessment (IPA). Would we also need to complete a Significant Change in Status Assessment (SCSA) at the same time due to these changes?Question: We have a resident for whom we are completing an Interim Payment Assessment (IPA). Would we also need to complete a Significant Change in Status Assessment (SCSA) at the same time due to these …
- 2022 Hurricane Waivers for Ian (South Carolina and Florida) and Fiona (Puerto Rico) (10/22)Hurricane Ian (South Carolina) Secretary Becerra used his authority in the Public Health Service Act to declare a public health emergency (PHE) on September 30, 2022, giving us the flexibility to support our beneficiaries in South Carolina, …
- CMS: 2023 Medicare Parts A & B Premiums and Deductibles (9/22)On September 27, 2022, the Centers for Medicare & Medicaid Services (CMS) released the 2023 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2023 Medicare Part D …
- CMS to End RUGs Support for Medicaid Case-Mix on Oct. 1, 2023; Gives States Guidance re: PDPM (9/22)Guidance on Nursing Facility State Plan Payment and Upper Payment Limit Approaches in Medicaid Relying on the Medicare Patient-Driven Payment Model (SMD 22-005) “As stated at the beginning of this letter, CMS will no longer …
- jRAVEN Free MDS Software Updated to v1.8.2 (9/22)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 …
- FY 2025 (Calendar Year 2023) SNF QRP APU Table for the MDS Data Submission ThresholdA table providing the data elements that will be required to meet the Annual Payment Update (APU) minimum data completion threshold for the Fiscal Year (FY) 2025 Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) …
- FY 2025 (Calendar 2023) SNF QRP Data Collection and Final Submission Deadlines (9/22)A table providing the data collection time frames and final submission deadlines for the Fiscal Year (FY) 2025 Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) is available. Note that the NHSN measure, Influenza Vaccination …
- FY 2024 (Calendar 2022) SNF QRP Data Collection and Final Submission Deadlines UPDATED (9/22)An updated table providing the data collection time frames and final submission deadlines for the Fiscal Year (FY) 2024 Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) is available. The FY 2024 update adds in …
- FY 2023 SNF QRP FAQs (9/22)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 …
- ICD-10 Coding: Keys to the Achieving the Highest SpecificityLike the Fiscal Year (FY) 2022 ICD-10-CM Official Guidelines for Coding and Reporting, the general coding guidelines in the FY 2023 ICD-10 Official Coding Guidelines instruct coders that “diagnosis codes are to be used and …
- PDPM At-a-Glance ToolThe PDPM At-a-Glance tool breaks down the complex methodology of each component used in the Patient-Driven Payment Model—physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), non-therapy ancillaries (NTA), and nursing. This tool provides key …
- Medicare Parts A & B Appeals Process: How the Five Levels of Appeal Work (9/22)This booklet informs health care providers about Medicare’s 5 appeal levels in Fee-for-Service (FFS) (Original Medicare) Parts A and B and includes resources on related topics. It also describes how providers, physicians, and suppliers apply …
- PDPM Grouper Updated (9/22)An updated version of the Patient Driven Payment Model (PDPM) Grouper V2.1000 has been posted. This update is just a documentation update to clarify the following: Jars are packaged differently (snf-x.x.x-jar-with-dependencies removed). Instead, jars in …
- HHS ASPE: State Use of Value-Based Payment in Nursing Facilities Issue Brief (9/22)Payers across the health care spectrum have begun transitioning from paying for quantity toward paying for quality. These value-based payment (VBP) programs vary in scope and focus, but generally share the goals of improving cost-savings …
- MLN Connects: Updated COVID-19 Vaccines Available at No Cost (9/22)The Department of Health & Human Services (HHS), through CMS announced that people with Medicare, Medicaid, Children’s Health Insurance Program coverage, private insurance coverage, or no health coverage can get COVID-19 vaccines, including the updated Moderna …
- SNF VBP Online Resources: New Updates for FY 2023 (9/22)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 …
- SNF QRP Measure Calculations and Reporting User’s Manual Plus Risk Adjustment File and Crosswalks – Updated (9/22)SNF QRP Quality Measure Calculations and Reporting User’s Manual V4.0, Change Table, Risk Adjustment Appendix File, and HCC ICD-10 Crosswalks The Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Quality Measure Calculations and Reporting User’s …
- FY 2023 – 2024 Parity Recalibrations Demand a Back-to-Basics ApproachFee-for-service Medicare Part A reimbursement is under significant pressure over the next two fiscal years due to a parity adjustment recalibration that will reduce aggregate payments by $780 million just in FY 2023 (Oct. 1, …
- Is Your Facility’s Medicare Reimbursement Faucet Leaking? 3 Areas to Check for RepairsNurse assessment coordinators’ (NACs’) actions drive the Medicare reimbursement that a skilled nursing facility (SNF) receives for the care it provides. NACs oversee the process of assessing residents, developing documentation, and submitting the MDS—all of …
- TIP: CMS Provides More Information on the iQIES Security OfficialCenters for Medicare & Medicaid Services (CMS) recently announced onboarding training for facility security officials for the iQIES. CMS posted the following materials to improve understanding of the onboarding process and a job aid for …
- 2022 Five-Star and Quality Measure ChangesIn 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 with AAPACN, talk about recent changes …
- Q&A: Can Z codes be used as the primary diagnosis?Question: I was told that, as of the April update of this year, we are no longer allowed to use Z codes as the primary diagnosis. Is this true? Answer by Carol Maher, RN-BC, RAC-MTA, …
- PBJ Takes Center-Stage: What the DNS Needs to KnowThe Payroll-Based Journal (PBJ) electronic staffing data system remains a little bit of a mystery to many directors of nursing services (DNSs), but the Centers for Medicare & Medicaid Services (CMS) is going all-in on …
- TIP: Transition to iQIES Will Require a Security OfficialThe Centers for Medicare & Medicaid Services (CMS) will be transitioning nursing homes to the Internet Quality Improvement and Evaluation System (iQIES) in the coming months. This system consolidates and replaces the Quality Improvement and …
- CMS Encourages States to Use Medicaid Payments to Nursing Homes to Drive Better Health Outcomes for Residents, Improve Staffing (8/22)CMS outlines actions for states to improve safety and quality of care for residents The Centers for Medicare & Medicaid Services (CMS) issued an informational bulletin detailing actions that states can take using existing Medicaid …
- FY 2023 ICD-10 codes for MDS V3.00.1 (FINAL) Data Submission Specs (8/22)An updated PDPM ICD Codes database for the MDS V3.00.1 (FINAL) Data Specifications is now available for download. The database contains two new tables. The table pdpm_icd_codes_FY2023 contains the allowed FY2023 codes for I0020B, while table …
- CMS: Part A Three-Day Hospital Stay Waiver Will Definitely End at COVID-19 PHE End (8/22)CMS has issued a new fact sheet with information about which COVID-19 Public Health Emergency (PHE) waivers and flexibilities have already been terminated, have been made permanent, or will end at the end of the …
- Get Ready: SNF QRP Data Submission Requirements Are IncreasingWhile key details are still pending, the Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule makes clear that meeting the reporting requirements of the Skilled Nursing Facility Quality Reporting …
- Q&A: Our billing department is being told by a third party that if we code any “unspecified” diagnoses in I8000, Medicare will deny it. Is this accurate?Question: Our billing department is being told by a third party that if we code any “unspecified” diagnoses in I8000, Medicare will deny it. Is this accurate? Answered by Jeff Taylor: This is absolutely false. …
- 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 …
- COVID-19 Medicare FAQs Updated (8/22)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 (8/16/22 Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction (PDF) (2/16/21) Frequently Asked …
- CMS Softens the Blow of the Parity Recalibration, but Change Is Coming QuicklyThe Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule may not “turn that frown upside down” as the popular saying goes, but it does give SNFs—and in some cases …
- Q&A: Can a resident be skilled for Medicare Part A and receive hospice care?Question: Can a resident be skilled for Medicare Part A and receive hospice care? Answer by Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: In order to cover someone on hospice for Medicare A, the …
- FY 2023 PDPM ICD-10 Mappings File (8/22)ICD-10-CM related mappings for the purposes of resident classification under the Patient-Driven Payment Model (PDPM) for Medicare Part A SNF stays. Updated all three mappings to FY2023 code list. Reflected all changes finalized in the …
- FY 2023 SNF PPS Final Wage Index Tables (8/22)CMS-1765-F Wage Index Tables for FY 2023 – Final (ZIP) From https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex
- FY 2023 SNF PPS Final Rule Press Release and Fact Sheet From CMS (7/22)Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2023; etc. PDF 348 Pages (962 KB)Permalink Press release: CMS Acts to Improve the …
- ICD-10-CM Codes: Use of Unspecified Codes Resulting in Medicare DenialsIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN, Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN, and Carol Maher, …
- Solve the Mystery of the Interrupted StayAh, the great mysteries of life. Which came first, the chicken or the egg? Is there intelligent life on other planets? Where do all the missing socks go? And of course, the enduring mystery: what …
- TIP: SNF QRP Provider Preview Reports AvailableThe Skilled Nursing Facility (SNF) Provider Preview Reports, which contain the performance scores of the SNF Quality Reporting Program (QRP) measures, were released in late July. These measures will be publicly reported on Care Compare …
- Q&A: Can a resident be skilled for Medicare Part A if they are receiving an oral antibiotic for an infection, such as pneumonia or cellulitis? Question: Can a resident be skilled for Medicare Part A if they are receiving an oral antibiotic for an infection, such as pneumonia or cellulitis? Answered by Jeff Taylor: Here’s a link to the Medicare …
- Interrupted Stay Tracker ToolFor Medicare residents, nurse assessment coordinators (NACs) need to determine whether an interrupted stay has occurred and ensure that the correct MDS assessments, both OBRA and PPS, are in place. AAPACN’s Interrupted Stay Tracker tool …
- Interrupted Stay Policy Quick GuideThe interrupted stay policy designates that a Medicare stay is considered a continuous stay when it is interrupted by less than three non-covered days. AAPACN’s Interrupted Stay Policy Quick Guide provides the key facts for …
- Interrupted Stay Flow ChartDetermining whether an interrupted stay has occurred can be a challenge, especially when so many different factors must be considered. AAPACN’s enhanced Interrupted Stay Flow Chart will help nurse assessment coordinators (NACs) navigate different scenarios to …
- Medicare A2400C Algorithm with the NPE and Interrupted StayAAPACN has adapted the A2400C flow chart from section A of the RAI User’s Manual to show how A2400C impacts how the nurse assessment coordinator (NAC) schedules the PPS Part A Discharge assessment and how …
- Q&A: Are physician certifications required for Medicare Advantage patients?Question: Are physician certifications required for Medicare Advantage patients? Answered by Karen Bernius, PT, RAC-CTA: There are no federal requirements, but you do need to check with the specific HMO/Medicare Advantage plan. We have found …
- CMS Report to Congress: Unified Payment for Medicare-Covered Post-Acute Care (7/22)The unified approach to case-mix adjustment includes standardized patient assessment data collected by the four PAC providers. Unified PAC Report to Congress (PDF) | Unified PAC Report to Congress Appendices (ZIP) Section 2(b)(2)(A) of the Improving Post-Acute …
- MedPAC June 2022 report on Medicare and the Healthcare Delivery System (6/22)The Medicare Payment Advisory Commission (MedPAC) releases its June 2022 Report to the Congress: Medicare and the Health Care Delivery System. Each June, as part of its mandate from the Congress, MedPAC reports on issues affecting the …
- AAPACN Responds to CMS’s Comment Request for FY 2023 SNF PPS Proposed RuleJessie McGill, RN, RAC-MT, RAC-MTA and Alexis Roam, MSN, RN-BC, DNS-CT, QCP The annual rulemaking process enables stakeholders to comment on proposals that will affect skilled nursing facilities (SNFs) throughout the next year. In early …
- TIP: CMS Releases Updated PBJ ManualThe Centers for Medicare & Medicaid Services (CMS) released the updated Version 2.6 Electronic Staffing Data Submission Payroll-Based Journal (PBJ) Long-Term Care Facility Policy Manual in June 2022. The update reinforces CMS’s message to validate …
- Quick Facts – SNF QRP Proposed Measure: Influenza Vaccination Coverage among Healthcare PersonnelThe Centers for Medicare & Medicaid Services (CMS) proposed a new Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) measure that will potentially be included in FY 2025 program year. The Influenza Vaccination Coverage Among …
- Q&A: A resident on Medicare Part A for skilled therapy could not participate with therapy for a few consecutive days due to a clinical condition. Can he remain on skilled care during those days?Question: A resident on Medicare Part A for skilled therapy could not participate with therapy for a few consecutive days because his Hemoglobin and Hematocrit were too low and he received blood transfusions. Will the …
- Medicare Part B Therapy Documentation Requirements MLN Fact Sheet (6/22)Complying with Outpatient Rehabilitation Therapy Documentation Requirements Fact Sheet ICN: MLN905365 Product Description: Learn how to correctly bill for outpatient Physical Therapy, Occupational Therapy, and Speech-Language Pathology services to avoid common billing errors when submitting claims to …
- Part A Physician Certs/Recerts: Don’t Strike Out on This Condition of PaymentPhysician certifications and recertifications are a technical requirement of payment (i.e., a condition of payment) under fee-for-service Medicare Part A. These certifications are needed to verify that a resident requires daily skilled care in a …
- Q&A: Should I complete an interim payment assessment (IPA) for a SNF resident who now tests positive for COVID and is newly receiving isolation for the active infection?Question: I have two residents in my facility that admitted skilled on Medicare Part A and they have since both tested positive for COVID-19. My administrator would like to claim the isolation days and has …
- 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 …