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.
- Q&A: If a resident on a Medicare Part A stay expires the same day as admission, is it a billable day?Question: If a resident on a Medicare Part A stay expires the same day as admission, is it a billable day?Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC:Yes, if a Medicare A resident …
- Q&A: A long-term resident has had a feeding tube for more than 10 years. He exhausted Medicare Part A benefits years ago. Can he be skilled with the new G-tube placement?Question: A long-term resident has had a feeding tube for more than 10 years. He exhausted his Medicare Part A benefits years ago. He recently experienced recurrent aspiration and had an extended hospitalization with a …
- TIP: The COVID-19 PHE Ended – Tools and ResourcesThe end of the COVID-19 public health emergency (PHE) on May 11, 2023, has marked the end of many waivers, including the 3-day qualifying hospital stay and benefit period waivers. For many new nurse assessment …
- Restorative Nursing Payment and Documentation Issues: Keys to SuccessRestorative nursing can impact fee-for-service Medicare Part A payment in the Behavioral Symptoms and Cognitive Performance category and the Reduced Physical Function category of the nursing component in the Patient-Driven Payment Model (PDPM), says Carol …
- AAPACN Advocates for Skilled Nursing Facilities: Response to Comment Request for FY 2024 SNF PPS Proposed RuleThe American Association of Post-Acute Care Nursing (AAPACN) team collaborated with its members and post-acute care experts to advocate for skilled nursing facility (SNF) professionals by making comments on the fiscal year (FY) 2024 SNF …
- CMS Nursing Home Data Sets UpdatedFive-Star, NHQI, SNF QRP, SNF VBP, PBJ data Data sets: 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 …
- FY 2024 SNF VBP Program June 2023 Quarterly Reports AvailableThe June 2023 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 Internet Quality Improvement and Evaluation System (iQIES). …
- TIP: New ABN Form Must Be Used by June 30, 2023In April 2023, the Centers for Medicare & Medicaid Services (CMS) released an updated Advanced Beneficiary Notice (ABN) form, CMS-R-131. This ABN form is used when Medicare Part B services end and a beneficiary notice …
- MLN Publication: SNF Three-Day Qualifying Hospital Stay and Medicare Billing RulesSkilled Nursing Facility 3-Day Rule Billing Format Fact Sheet ICN: MLN9730256 Publication Description: Learn communication of coverage, claims processing edits, and financial responsibility. https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/snf3dayrule-mln9730256.pdf
- NHSN Healthcare Personnel (HCP ) Flu Vaccination Module for SNF QRP ReportingThe 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 …
- SNF QRP: 2023 Impact of Mississippi Stormshttps://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 PHE End FAQsThe federal PHE for COVID-19, declared under Section 319 of the Public Health Service Act, expired at the end of the day on May 11, 2023. Learn more by reading Frequently Asked Questions: CMS Waivers, Flexibilities, …
- CMS Transmittal: SNF Consolidated Billing HCPCS Code File Update for July 2023Transmittal # R12052CP Issue Date 2023-05-18 Subject July 2023 Quarterly Update to Healthcare Common Procedure Coding System (HCPCS) Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement Implementation Date 2023-07-03 CR # 13192 …
- Best Practices to Dispute Takebacks for Medicare/Insurance Begin With PreventionIn the 1730s, Benjamin Franklin wrote “An ounce of prevention is worth a pound of cure” to inspire the city of Philadelphia to adopt better fire prevention techniques. What he delivered to history was a …
- Q&A: Would therapy 5 times a week prevent a 60-day wellness period?Question: I have a resident who had a recent 3-day qualifying stay for Medicare Part A. He had exhausted all benefits in January but continued to have Medicare Part B therapy 5 days a week for …
- Q&A: For the Nursing component of PDPM, a resident with a diagnosis of Parkinson’s disease with a function score of 15 was calculated into the Physical Function Reduced PA1 case-mix group and not into Clinically Complex. Is this a software error?Question: For the Nursing component of PDPM, a resident with a diagnosis of Parkinson’s disease with a function score of 15 was calculated into the Physical Function Reduced PA1 case-mix group and not into Clinically …
- TIP: SNFs Still Must Use Condition Code DR After the COVID-19 PHE EndsThe Centers for Medicare & Medicaid Services (CMS) clarified on a recent MLN Connects newsletter that skilled nursing facilities (SNFs) must continue to use the condition code DR (disaster related) on Medicare Part A claims …
- CMS Transmittal: SNF 5-Claim Probe and Educate ReviewTransmittal 12032 issued May 10, 2023, is being rescinded and replaced by Transmittal 12037, dated May 15, 2023, to make a minor clarification (that claims will be adjusted/denied if an improper payment is identified) and …
- CMS Transmittal Revised: SNF PPS PDPM Claims Processing Updates to Current EditingIssue Date 2023-05-08 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Patient-Driven Payment Model (PDPM) Claims Processing Updates to Current Editing Transmittal 11988 issued April 21, 2023, is being rescinded and replaced by Transmittal 12023, …
- SNF QRP: Discharge Function Score for SNFs Draft Technical Report: Imputation Appendix FileCMS has posted the Discharge Function Score for Skilled Nursing Facilities (SNFs) Draft Technical Report: Imputation Appendix File, which accompanies the Discharge Function Score for Skilled Nursing Facilities (SNFs) Draft Technical Report. The Imputation Appendix …
- OIG Inspector General Continues to Prioritize Nursing HomesKey excerpt: Nursing Homes We know that compliance helps an organization remain focused on providing high-quality care. OIG work has pinpointed breakdowns in quality of care across many health care sectors. Perhaps the most pronounced …
- TIP: CMS Released Updated FAQ on the End of the COVID-19 PHEIn late April, CMS updated the resource “Frequently Asked Questions: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency.” This document addresses key questions regarding billing for vaccines, Medicare coverage, the 3-day …
- Q&A: A resident had a fall at home that resulted in a fracture but did not receive surgery. The provider’s progress notes indicated, “Unspecified fall, initial encounter” (W19.XXXA), as the primary medical diagnosis. Should I use this diagnosis?Question: A resident had a fall at home that resulted in an acetabular fracture but did not receive surgery. The provider’s progress notes indicated, “Unspecified fall, initial encounter” (W19.XXXA), as the primary medical diagnosis. Should …
- CMS QSO Memo Guidance for the Expiration of the COVID-19 Public Health Emergency (PHE)Includes a three-page section, Long Term Care Facilities (Skilled Nursing Facilities (SNFs) and/or Nursing Facilities (NFs)), plus guidance for all providers on staff vaccinations and emergency preparedness. Memo # QSO-23-13-ALL Posting Date 2023-05-01 Fiscal Year …
- Q&A: A resident on Medicare Part A went out on a leave of absence (LOA) for a temporary home visit on Saturday and returned on Monday. How do we bill this?Question: A resident on Medicare Part A went out on a leave of absence (LOA) for a temporary home visit on Saturday and returned on Monday. How do we bill this? Answer from Carol Maher, …
- TIP: CMS Releases Optional State Assessment (OSA) Item Set and ManualOn April 24, the Centers for Medicare & Medicaid Services (CMS) posted the Optional State Assessment (OSA) Item Set, OSA Manual, and OSA Change History table in the Downloads section on the Minimum Data Set …
- TIP: CMS Clarified End of COVID-19 Waivers Impact on 30-Day Transfer RuleAAPACN received clarifying information from the Centers for Medicare & Medicaid Services (CMS) related to the end of the COVID-19 public health emergency (PHE) and how residents covered under Medicare Part A using the 3-day …
- Optional State Assessment (OSA) Item Set and OSA Manual for Oct. 1, 2023 ImplementationThe Optional State Assessment (OSA) Item Set, OSA Manual, and OSA Change History table are now available in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. The OSA is …
- White Paper: FY 2024 SNF PPS Proposed Rule: SNF QRP and SNF VBP Changes GaloreThe Centers for Medicare & Medicaid Services (CMS) recently posted the Fiscal Year (FY) 2024 Skilled Nursing Facility Prospective Payment System (SNF PPS) proposed rule for public inspection. The payment news is good—a 3.7 percent …
- NAC Quick Reference Guide to the End of the COVID-19 PHE WaiversThe Centers for Medicare & Medicaid Services (CMS) has announced the COVID-19 public health emergency (PHE) will end on May 11, 2023. The end of the PHE declaration also marks the end of temporary waivers …
- ABN (Form CMS-R-131) for Part B SNF Services: New Forms Mandatory 6/30/23The ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. The use of the renewed form with the expiration date of 01/31/2026 will be mandatory on 6/30/23. …
- Proposed CoreQ: Short Stay Discharge Survey Measure Survey Protocols and Guidelines ManualCoreQ: Short Stay Discharge Survey CoreQ Short Stay Discharge Survey Protocols and Guidelines Manual and additional resources CMS-10852 (ZIP) From https://www.cms.gov/regulations-and-guidance/legislation/paperworkreductionactof1995/pra-listing/cms-10852
- SNF VBP SNF WS PPR Draft SpecificationsFrom https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/value-based-programs/snf-vbp/measure
- SNF QRP Quick Reference GuideAn 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. https://www.cms.gov/files/document/pac-snf-quickreferenceguide-20230207.pdf From https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Data-Submission-Deadlines
- FY 2024 SNF PPS Proposed Rule: SNF QRP and SNF VBP Changes GaloreOn April 4, 2023, the Centers for Medicare & Medicaid Services (CMS) posted the Fiscal Year (FY) 2024 Skilled Nursing Facility Prospective Payment System (SNF PPS) proposed rule for public inspection. The payment news is …
- Draft FY 2024 PDPM ICD-10 Mapping ToolIncludes tables with proposed changes. FY 2024 DRAFT PDPM ICD-10 Mapping (ZIP) (see FY 2024 SNF PPS Proposed Rule) From https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/PDPM
- FY 2024 SNF PPS Proposed Rule and Fact SheetProposed rule: https://www.federalregister.gov/public-inspection/2023-07137/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities Fact Sheet: On April 4, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare payment policies and rates for skilled nursing facilities under the …
- Q&A: If an interim payment assessment (IPA) is determined to have a new primary diagnosis, does therapy need to re-evaluate the resident or can they continue treatment based on the 5-Day diagnosis?Question: If an interim payment assessment (IPA) is determined to have a new primary diagnosis, does therapy need to re-evaluate the resident or can they continue treatment based on the 5-Day diagnosis? Answer from Carol …
- TIP: The End of the COVID-19 PHE Impact on a Skilled StayOn March 2, 2023, the Centers for Medicare & Medicaid Services (CMS) hosted a Skilled Nursing Facilities (SNF)/Long-Term Care (LTC) Open Door Forum. During the call, a CMS official clarified the answer to a question …
- CMS Transmittal: Enhancements to PDPM Claim Edits to Improve Claim ProcessingTransmittal 11879 issued February 24, 2023, is being rescinded and replaced by Transmittal 11932, dated, March 29, 2023, to update Business Requirement (BR) 12896.3 to match FISS new reason code and to add BR 12896.3.1. …
- Fiscal Management and Budget Efficiency During Lean TimesWhen a skilled nursing facility (SNF) is operating on a tight budget, while also being census- and staff-challenged, the director of nursing services (DNS) needs to be more directly and proactively involved in fiscal management …
- SNF QRP: SNF Discharge Function Score Technical ReportThis report presents the Discharge Function Score measure specifications. Section 2 provides an overview of the measure and a high-level summary of the key features of the measure that are described in detail in the …
- MedPAC March 2023 Report: Medicare Payment PolicyThe Medicare Payment Advisory Commission (MedPAC) has released its March 2023 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 …
- Q&A: Can I cover a resident under Medicare Part A who is receiving hospice care at the same time, or does the resident need to disenroll from hospice first?Question: Can I cover a resident under Medicare Part A who is receiving hospice care at the same time, or does the resident need to disenroll from hospice first? Answer from Carol Maher, RN-BC, RAC-MTA, …
- Q&A: A resident on Medicare Part A admitted during the weekend. How much time do I have to open the 5-Day PPS assessment?Question: A resident on Medicare Part A admitted during the weekend. How much time do I have to open the 5-Day PPS assessment? Answer from Jeff Taylor:The 5-Day PPS assessment must be opened before the …
- CMS Section GG Training Videos: GG0130A, GG0110, GG0170C, GG0130B, Decision Tree for GG0130/GG0170Video Tutorials Available to Assist with Coding Specific Section GG Items The Centers for Medicare & Medicaid Services is releasing a series of short videos to assist providers with coding select Section GG items on …
- SNF VBP Program Frequently Asked QuestionsFrom https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/SNF-VBP/SNF-VBP-Page
- March 2023 Quarterly Confidential Feedback Reports for the FY 2024 SNF VBP Program Are AvailableThe March 2023 Quarterly Confidential Feedback Reports for the FY 2024 SNF VBP Program are now available to download via the Quality Improvement and Evaluation System (QIES)/Certification and Survey Provider Enhanced Reports (CASPER) reporting system. …
- Set up an Audit Response Process to Navigate TPESkilled nursing facilities (SNFs) seem to be experiencing a significant uptick in Targeted Probe and Educate (TPE) prepayment medical review of fee-for-service Medicare Part A claims, says Stacy Grondel, RN, BN, RAC-CTA, RAC-MT, QCP, CMAC, director …
- TIP: CMS Announces MDS Submission Transition to iQIES April 2023CMS announced that the transition of MDS assessment submission and reporting to the Internet Quality Improvement and Evaluation System (iQIES) will occur on Monday, April 17, 2023. Nursing facilities currently use the QIES Assessment Submission …
- CMS Updates MSP Manual: Providers Can’t Refuse to Treat Medicare Beneficiaries With Certain MSP RecordsTransmittal # R11874MSP Issue Date 2023-02-23 Subject Significant Updates to Internet Only Manual (IOM) Publication (Pub.) 100-05 Medicare Secondary Payer (MSP) Manual, Chapter 3 Implementation Date 2023-03-24 CR # 13085 Publication # 100-05 R11874MSP (PDF) …
- CMS Analysis Provides Insight into SNF 3-Day Waiver in Accountable Care Organizations (ACOs)A new CMS analysis describes trends in use and outcomes associated with waiving the three consecutive day inpatient stay requirement at an acute care hospital before discharge to a skilled nursing facility (SNF). The 3-day waiver for certain accountable care organizations (ACOs) …
- How NACs Can Support Administrative Level of Care Presumption During Medical ReviewWhen a Medicare beneficiary is admitted to a skilled nursing facility (SNF), there are specific requirements that the resident must meet for the facility to bill Medicare for the services provided. The physician must certify …
- TIP: CMS Outlines How the End of the COVID-19 PHE Will Impact Medicare BeneficiariesThe Biden Administration recently announced the end of national COVID-19 public health emergency (PHE) declarations and extensions, which will occur on May 11, 2023. On page 125 of the COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service …
- Q&A: Therapy is discharging a Medicare Part A resident, but he will continue to be skilled for daily nursing services. Do I need to complete any MDS assessments to reflect this change?Question:Therapy is discharging a Medicare Part A resident, but he will continue to be skilled for daily nursing services. Do I need to complete any MDS assessments to reflect this change? Answer from Janine Cortesa, …
- April 2023 Quarterly Update to SNF Consolidated Billing HCPCS CodesTransmittal # R11849CP Issue Date 2023-02-09 Subject April 2023 Quarterly Update to HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement Implementation Date 2023-04-03 CR # 13089 Publication # 100-04 Downloads I. …
- 2022 NASEM Quality of Nursing Home Report – Moving Recommendations to ActionFrom the John A. Hartford Foundation: Public Policy & Aging Report (PP&AR) has released a Special Issue, “2022 NASEM Quality of Nursing Home Report: Moving Recommendations to Action.” PP&AR, a publication of The Gerontological Society of America, supplemental issue focuses …
- Comprehensive Dementia Care – Five Key Payment RecommendationsFrom the John A. Hartford Foundation: Health Affairs Forefront: Payment for Comprehensive Dementia Care – Five Key Recommendations Health Affairs Forefront has published an article on “Payment for Comprehensive Dementia Care: Five Key Recommendations,” calling on the Centers …
- Q&A: Is there an interrupted stay policy quick guide for billers that I can use as a reference?Question: Is there an interrupted stay policy quick guide for billers that I can use as a reference? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: AAPACN has a lot of great resources on …
- Medicare Medical Review Contractors OverviewSince the Medicare program is heavily monitored for improper payments to protect the Medicare Trust Fund, it is likely your facility will experience a medical review by a Medicare contractor. The AAPACN Medicare Medical Review …
- TIP: BFCC-QIO’s Updated Notification Process for New Appeals Started January 17Starting on Jan. 17, 2023, post-acute care facilities and Medicare health plans will no longer receive phone calls for appeal notifications. The initial notification, medical record requests, and case outcomes for post-acute care facilities and …
- TPE Medical Review Prep: Revive These MDS Best PracticesThe general consensus is that Medicare Administrative Contractors (MACs) are targeting—more than ever before—skilled nursing facility (SNF) fee-for-service Medicare Part A claims for Targeted Probe and Educate (TPE) prepayment medical review. SNFs that undergo TPE audits …
- Back to Basics: Returning to Pre-Pandemic Medicare Regulatory ComplianceSince March of 2020, skilled nursing facilities (SNFs) have relied on two distinct waivers related to technical eligibility for Medicare. Due to the COVID-19 Public Health Emergency (PHE), temporary changes related to the 3-day qualifying …
- 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 …
- 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 …
- 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 …
- 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 …
- 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 …
- 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 …
- 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 …
- 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 …
- 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 …