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.
- MLN Network Provider Minute Video: The Importance of Proper DocumentationThis video will help providers and physicians understand the need and importance of medical record documentation to support the services billed. Watch this video to learn more about what the CERT program has identified as …
- 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 …
- PDPM Grouper UpdateThe “PDPM Grouper JAR Package V2.2001.zip” is now available. This V2.2001 release is an update to adjust the OBRA logic for target dates on or after October 1, 2023. The logic for standalone OBRA assessments will …
- 2025 Medicare Advantage Proposed Rule Includes Some SNF-Related ProposalsBiden-Harris Administration Proposes to Protect People with Medicare Advantage and Prescription Drug Coverage from Predatory Marketing, Promote Healthy Competition, and Increase Access to Behavioral Health Care in the Medicare Advantage Program Fact sheet Contract Year …
- CY 2024 Final Physician Fee Schedule and Other Part B ProposalsNov 02, 2023 https://www.cms.gov/newsroom/press-releases/cms-finalizes-physician-payment-rule-advances-health-equity Final policies will expand behavioral health services, advance the President’s Cancer Moonshot, support family caregivers, and accelerate value-based care The Centers for Medicare & Medicaid Services (CMS) announced it is finalizing policies …
- Stop and Read: Skilled Documentation Audit and Education Lessons for the NACSkilled nursing facilities (SNFs) are increasingly subject to skilled medical review audits from both fee-for-service Medicare (e.g., the SNF Five-Claim Probe and Educate initiative) and individual Medicare Advantage plans. Audit success ultimately hinges on documentation …
- SNF PPS MedPAC Payment Basics Fact Sheet / Educational ToolPAYMENT BASICS: SNF PPS Skilled nursing facility services payment system Additional payment basics tools: https://www.medpac.gov/document-type/payment-basic/
- CMS Nursing Home Data Sets UpdatedThe October 2023 release of the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) data is now available on Care Compare and Provider Data Catalog (PDC). The data are based on quality assessment data submitted by SNFs to …
- Lessons From TPE Audits: How the DNS Can Lead Toward Better Skilled DocumentationIn May 2023—after the Comprehensive Error Rate Testing (CERT) program determined that skilled nursing facility (SNF) Medicare Part A services have been “a top driver” of the overall Medicare fee-for-service improper payment rate since the …
- CMS Post-Acute Care Health Equity Confidential Feedback Reports, Online Webinar, and Fact SheetAs part of our commitment to advance health equity and strengthen the Medicare Program, the Centers for Medicare & Medicaid Services (CMS) has released two Health Equity Confidential Feedback Reports to post-acute care (PAC) providers: the …
- Q&A: A Medicare Part A resident expired three days after admission. He received skilled nursing services only and did not complete any MDS interviews. Is a 5-Day PPS assessment needed?Question: A Medicare Part A resident expired three days after admission. He received skilled nursing services only and did not complete any MDS interviews. Is a 5-Day PPS assessment needed? Answer from Carol Maher, RN-BC, …
- Q&A: Does the physician or physician extender have to acknowledge at risk for malnutrition prior to the assessment reference date (ARD) to code it in section I?Question: Does the physician or physician extender have to acknowledge at risk for malnutrition prior to the assessment reference date (ARD) to code it in section I? Answer from Jeff Taylor: Risk for malnutrition is …
- 2024 Medicare Parts A & B Premiums and DeductiblesFrom https://www.cms.gov/newsroom/fact-sheets/2024-medicare-parts-b-premiums-and-deductibles On October 12, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2024 Medicare …
- CMS Transmittals Update Manuals to Exclude Marriage and Family Therapist and Mental Health Counselor Services From Consolidated BillingTransmittal #R12283CP Issue Date 2023-10-05 Subject Internet Only Manual Updates to Pub. 100-02 and 100-04 to Implement Consolidated Appropriations Act 2023 Changes for Skilled Nursing Facility (SNF) Policy: The Consolidated Appropriations Act, 2023 (Pub. L. …
- CMS Transmittal: PDPM Corrections to Interrupted Stay EditsTransmittal #R12286OTN Issue Date 2023-10-05 Subject Patient Driven Payment Model (PDPM) Corrections to Interrupted Stay Edits Implementation Date 2024-04-01 CR #13360 Publication #100-20 Transmittal Year 2023 Downloads
- Q&A: Is there a requirement that we complete a 5-Day assessment for HMOs or Medicare Advantage plans?Question: Is there a requirement that we complete a 5-Day assessment for HMOs or Medicare Advantage plans? Answer from Jeff Taylor: Each payer makes its own rules regarding what’s required for reimbursement. This is essentially …
- Q&A: We identified that we could have completed an Interim Payment Assessment (IPA) on a resident back in July. Is there a timeframe that allows you to go back and open that IPA and complete it? Question: We identified that we could have completed an Interim Payment Assessment (IPA) on a resident back in July. Is there a timeframe that allows you to go back and open that IPA and complete it? …
- Q&A: We completed a combined 5-Day/Admission assessment on day 15 of the stay. After submission, our system shows we are out of compliance for CAAs/MDS based on the signature/completion date. Do we need to bill default for the one day we were out of compliance?Question: We completed a combined 5-Day/Admission assessment on day 15 of the stay. After submission, our system shows we are out of compliance for CAAs/MDS based on the signature/completion date. Do we need to bill …
- 2024 SNF Consolidated Billing HCPCS Code Annual Update TransmittalTransmittal #R12266CP Issue Date 2023-09-28 Implementation Date 2024-01-02 CR #13394 Publication #100-04 Transmittal Year 2023 R12266CP
- Preparing for Success with ICD-10-CM Changes Oct. 1: How the Facility Coder and Provider Can Ensure Accurate Diagnosis CodesEffective International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM) coding relies on meticulous clinical documentation. It’s not just about assigning codes; it’s about ensuring consistent and comprehensive documentation that substantiates every facet and the …
- TIP: CMS Updates SLP-Related Comorbidities, Removing All Parkinson’s Disease CodesOn Sept. 18, 2023, the Centers for Medicare & Medicaid Services (CMS) added a note within the Fiscal Year (FY) 2024 PDPM ICD-10 Mapping file that effectively removed several diagnosis codes from impacting the Speech-Language …
- Provider ICD-10-CM Documentation Tip Sheet for Long-Term CareICD-10-CM coding requires consistent and complete documentation from the provider (physician/nonphysician practitioner) to support all aspects and specific details of the diagnosis. This AAPACN Provider ICD-10-CM Documentation Tip Sheet for Long-Term Care tool serves as …
- FY 2024 ICD-10-CM Codes and Coding Guidelines Effective Oct. 1, 2023: Errata and Updated Files2024 release of ICD-10-CM October 1, 2023 release of ICD-10-CM The FY2024 ICD-10-CM codes are to be used from October 1, 2023 through September 30, 2024. Note: This replaces the FY 2023 – April 1, …
- FY 2024 PDPM ICD-10-CM Mappings File UpdatedFrom https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf/patient-driven-model
- 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 …
- Oct. 1, 2023 Will See Performance Period Data Collection for Five SNF VBP QMsThe key takeaway of the Fiscal Year (FY 2024) Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule, published on Aug. 7, 2023, is that the director of nursing services (DNS) will need to …
- SNFRM: Technical Specifications for This SNF VBP Measure2023 Measure Updates and Specifications Report Skilled Nursing Facility Value-Based Purchasing Program Skilled Nursing Facility 30-Day All-Cause Readmission Measure –Version 2.0 This report describes updates that have been made to the Skilled Nursing Facility 30-Day …
- SNF QRP FAQs for FY 2024An 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 …
- FY 2024 SNF PPS Final Rule Initial Timeline for NACs: How/When the MDS Takes Center-StageBreathing room will be in short supply for nurse assessment coordinators (NACs) and other interdisciplinary team members who need to implement and monitor the multitude of changes to the Skilled Nursing Facility Quality Reporting Program …
- Q&A: A resident exhausted benefits in March 2023 with a new G-tube and 100% tube feeding. She was recently admitted to the hospital for three days and had the G-tube removed and was eating by mouth. Can this resident be skilled for Medicare Part A? Question: A resident exhausted benefits in March 2023 with a new G-tube and 100% tube feeding. She was recently admitted to the hospital for three days and had the G-tube removed and was eating by …
- FY 2024 SNF VBP Program Fact Sheet, Timeline, and FAQsFY 2024 SNF VBP Resources
- FY 2026 (Calendar Year 2024) SNF QRP APU Table for the MDS Data Submission ThresholdThe FY 2024 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule (88 FR 53200) revised data collection and submission requirements for the SNF Quality Reporting Program (QRP) affecting the Fiscal Year (FY) 2026 …
- FY 2025 (Calendar Year 2023) SNF QRP APU Table for the MDS Data Submission Threshold–RevisedThe FY 2024 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule (88 FR 53200) revised data collection and submission requirements for the SNF Quality Reporting Program (QRP) affecting the Fiscal Year (FY) 2025 …
- FY 2026 (Calendar 2024) SNF QRP Data Collection and Final Submission Deadlineshe FY 2024 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule (88 FR 53200) revised data collection and submission requirements for the SNF Quality Reporting Program (QRP) affecting the Fiscal Year (FY) 2026 …
- FY 2025 (Calendar 2023) SNF QRP Data Collection and Final Submission Deadlines — RevisedThe FY 2024 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule (88 FR 53200) revised data collection and submission requirements for the SNF Quality Reporting Program (QRP) affecting the Fiscal Year (FY) 2025 …
- SNF QRP QM Calculations and Reporting User’s Manual V5.0, Change Table, Risk Adjustment and Imputation Appendix Files, and HCC ICD-10 CrosswalksThe Skilled Nursing Facility Quality Reporting Program (SNF QRP) Quality Measure Calculations and Reporting User’s Manual Version 5.0 serves as an update to the specifications used to calculate quality measures that are included in the SNF …
- Optional State Assessment (OSA) Item Set and OSA Manual for Oct. 1, 2023 Implementation–UpdatedThe Optional State Assessment (OSA) Item Set and OSA Manual have been updated, and the updated versions are now available in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. …
- Business Case TemplateThere are times when the nursing department needs new solutions or process changes to enhance resident care or improve staff workload. Often, these are high-cost solutions that require approval from the governing body, executive staff, …
- Effective Business Case Development for Budget Wins and Better Care OutcomesThe phrase “budget development time” often elicits moans and groans from facility leadership. During this process, leadership usually asks the director of nursing services (DNS) if he or she has any requests of items to …
- The DNS’s Role in the Annual BudgetIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT, curriculum development specialist for AAPACN, discuss the director of nursing services’ …
- Recent CMS Transmittals: SNF QRP Reporting Requirements and SNF PPS Pricer UpdateR12182QRI 2023-08-03 Fiscal Year 2018 and After Payments to Skilled Nursing Facilities (SNFs) That Do Not Submit Required Quality Data – This CR Rescinds and Fully Replaces CR 9944. 2023-09-04 13242 R12174CP 2023-08-03 Medicare Part …
- TIP: CMS Updated the Five-Star Administrator Turnover Exclusion CriteriaEffective with the July 2023 Five-Star refresh, the Centers for Medicare & Medicaid Services (CMS) revised the nursing-home level exclusion criteria on an erroneously high number of administrators applied to the administrator turnover measure. Previously, …
- FY 2024 SNF PPS Final Rule and Correction NoticeThe final rule and key files: Final Rule Permalink Correction Notice: https://www.federalregister.gov/documents/2023/10/04/2023-22050/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities FY 2024 PDPM ICD-1- Mapping (ZIP) (effective 10-01-2023) CMS-1779-F Wage Index Tables for FY 2024 – Final (ZIP) PDPM Case-Mix – Tables 5 and 6 …
- Q&A: How do I determine if a resident needs a new qualifying hospital stay to use remaining Medicare benefits?Question: A resident was in our skilled nursing facility (SNF) stay with a qualifying hospital stay over a month ago. She was skilled in our facility until a week ago when she discharged home. She …
- Q&A: I submitted an Admission/5-Day assessment and recently learned that the 5-Day is not needed because Managed Care is the payer, not Medicare. How do I correct this?Question: I have a resident who we thought was Medicare Part A and completed and submitted an Admission/5-Day assessment. I am now being told that the resident was Managed Care and I need to inactivate …
- TIP: Facilities Must Update ICD-10-CM Diagnosis Codes by Oct. 1, 2023The Centers for Medicare & Medicaid Services (CMS) released the revised ICD-10-CM diagnosis codes for fiscal year 2024, which will become effective Oct. 1, 2023. Facility staff will need to review diagnosis codes for residents …
- CMS Transmittal: SNF PDPM Claims Processing Edits UpdateR12146OTN Issue Date 2023-07-21 Subject The purpose of this Change Request (CR) is to update current Skilled Nursing Facility (SNF) PDPM claims processing edits in order to process and pay claims correctly. A. Background: This …
- BIMS MDS Coding Video Tutorial UpdatedThe Centers for Medicare & Medicaid Services (CMS) is offering an updated video tutorial to assist providers with guidance application and interview strategies for the cognitive assessment known as the Brief Interview for Mental Status …
- Q&A: We have a resident who was admitted with a Peg tube about a year ago. He was hospitalized and had it replaced. The resident returned to us under Medicare. Does anyone know if you would consider this a new Peg tube and would the resident qualify to utilize the 100 days?Question: We have a resident who was admitted with a Peg tube about a year ago. He was hospitalized and had it replaced. The resident returned to us under Medicare. Does anyone know if you …
- TIP: Medicare Advantage PPS Assessments Are Not Submitted to iQIESThe RAI User’s Manual clarifies that PPS assessments that are completed for the purpose of insurance payment, such as with a Medicare Advantage (MA) plan, are not CMS required assessments and are not to be …
- OSA Crash Course: Keys to Navigating this Medicaid-Only Payment AssessmentIn a number of Medicaid case-mix states, the MDS v1.18.11 item sets won’t be the only MDS item sets that are implemented on Oct. 1, 2023—a fact that should temper some excitement about certain MDS …
- How Will October 2023 MDS Changes Impact PDPM and Medicare Payment?Many changes are coming to the Minimum Data Set (MDS) effective Oct. 1, 2023. The Centers for Medicare & Medicaid Services (CMS) released the draft of the Long-Term Care Resident Assessment Instrument (RAI) User’s Manual …
- Review of ICD-10-CM Changes Effective Oct. 1, 2023In this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN, discuss some …
- Medicare Managed Care Basics: Critical Intel for the DNSData from the Centers for Medicare & Medicaid Services (CMS) shows that, as of January 2023, half of all Medicare beneficiaries are now enrolled in a Medicare Advantage plan, according to a recent Kaiser Family …
- 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 …
- CMS Releases Medicare Advantage Skilled Nursing Facility Utilization DataThe Centers for Medicare & Medicaid Services (CMS) updated two data products with skilled nursing facility utilization data for beneficiaries enrolled in Medicare Advantage (MA). The Medicare Advantage Geographic Variation PUF (MA GV PUF) now …
- 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 …
- 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 …
- 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
- 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
- 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 …
- 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 …
- 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) …