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 Maps Out Four Years of Big Changes and Forecasts Even MoreIn the Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) and Consolidated Billing Proposed Rule for Fiscal Year (FY) 2027, officially published on April 7, 2026, the Centers for Medicare & Medicaid Services (CMS) …
- TIP: CMS Proposed Major Changes to SNF QRP ProgramThe Centers for Medicare & Medicaid Services (CMS) recently released the fiscal year (FY) 2027 SNF PPS Proposed Rule. Stakeholders have until June 1, 2026, to submit comments on the proposals. The following is a …
- Q&A: Can Medicare Part A continue for a new pressure ulcer not related to the hospital stay?Question: A resident admitted after hospitalization is completing therapy but developed an unstageable pressure ulcer during the SNF stay. Can Medicare Part A continue for skilled nursing, even though the condition was not part of …
- FY 2027 SNF PPS Proposed Rule: Associated ResourcesFrom https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf/list-federal-regulations/cms-1843-p DRAFT SNF QRP New and Modified Items with a Proposed Effective Date of October 1, 2031: FY27_Proposed_Rule_SNF_All_Payer_draft_mockups_MDS__508.pdf (PDF) From https://www.cms.gov/medicare/quality/snf-quality-reporting-program/measures-and-technical-information Draft MDS re: proposed removal of MDS item O0350 on Oct. 1, 2027: CMS-10387 from https://www.cms.gov/regulations-and-guidance/legislation/paperworkreductionactof1995/pra-listing-items/cms-10387
- Ancillary Billing Review: Why the DNS Must Lead the Financial-Clinical ConversationAs the clinical leader of the largest operational department in a skilled nursing facility, the director of nursing services (DNS), in tandem with the administrator, plays a key role in financial oversight. Ancillary charges are …
- Ancillary Billing Review ChecklistThe director of nursing services should review ancillary billing monthly to ensure that all billed services and supplies are clinically appropriate, documented accurately, and supported by skilled nursing care. The DNS can use this Ancillary …
- FY 2027 SNF PPS Proposed RuleProspective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2027 Filed on: 04/02/2026 at 5:15 pm Scheduled Pub. Date: 04/07/2026 PDF 114 Pages (397 …
- ICD-10-CM Coding Spotlight Series – Part 3: Sweet Details Matter: Navigating Diabetes ICD-10-CM CodingSeasonal celebrations often remind us how quickly small choices can add up. A little handful of candy or a few fruit jelly slices may seem insignificant, but piece by piece they do make an impact. …
- 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 …
- TIP: Updated ABN (CMS-R-131) Now AvailableThe Centers for Medicare & Medicaid Services (CMS) has released the updated Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131. The notice had expired in January 2026, but CMS instructed facilities to continue issuing the …
- CMS Finalized Standards for Claims Attachments and Electronic Signatures to Phase Out Fax Machines, Snail Mail for Claims-Related DocumentationThe Centers for Medicare & Medicaid Services (CMS), on behalf of the U.S. Department of Health and Human Services (HHS), is making our shareholders aware of the “Adoption of Standards for Health Care Claims Attachments …
- ABN (Form CMS-R-131) for Part B SNF ServicesThe Office of Management and Budget (OMB) has approved the control number for the Advance Beneficiary Notice of Non-coverage (ABN) (CMS-R-131). CMS is notifying the industry through our website, and the Medicare Learning Network and …
- FY 2027 SNF VBP March 2026 Quarterly Reports AvailableThe March 2026 Quarterly Confidential Feedback Reports for the fiscal year (FY) 2027 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program are now available to download via the Internet Quality Improvement and Evaluation System (iQIES). …
- PDPM Admission Documentation Request ToolConsistency in documentation is vital to code the MDS accurately. Several MDS items use hospital records to support coding, such as diagnoses, recent surgery, IV fluids/feeding, and tube feeding. Use the PDPM Admission Documentation Request …
- ICD-10-CM Coding Spotlight Series – Part 2: Navigating Genitourinary Conditions in Long-Term CareAs National Kidney Month arrives in March, so does an important reminder: our kidneys work quietly every day, filtering waste, balancing fluids, and supporting overall health. Now is the perfect time for facility coders in …
- How the NAC and the IDT Can Be Predictive vs. Reactive With QM Data: AAPACN 2026 Conference HighlightThe watchword that increasingly defines federal (and some state) programs that drive nursing home operations and payment is connectedness, says Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, IPCO, QCP, ICC, director of reimbursement and education for …
- BFCC-QIO Medicare Advantage Appeals in SNFs Slide Set and Webinar RecordingMedicare Advantage Plan Appeals in Skilled Nursing Facilities Date presented: January 21, 2026 In this webinar, Acentra Health provices a look at a recent focus study on how Medicare Advantage plans use NOMNCs in SNFs. During …
- AAPACN 2026 Conference Highlight – Express Pass to Precision: Tackling Tricky ICD-10-CM Scenarios in Long-Term CareIn this LTC NAC Chat podcast episode, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist for AAPACN, discuss some …
- Q&A: Can I set a 5-Day PPS assessment on a non-billable day such as a skip day? The resident was sent to the hospital, did not return prior to midnight, and was not admitted.Question: Can I set a 5-Day PPS assessment on a non-billable day such as a skip day? The resident was sent to the hospital, did not return prior to midnight, and was not admitted. Answer …
- ICD-10-CM Coding Spotlight Series – Part 1: Coding with Heart: Navigating ICD-10-CM Cardiac Coding in Long-Term CareFebruary’s designation as American Heart Month offers an important opportunity to reflect on the role of cardiovascular health in long-term care (LTC). Cardiac conditions such as heart disease, hypertension (HTN), and heart failure are among …
- Q&A: The SNF QRP Data Validation Audit notification letter requested Admission and Discharge assessments. What assessments should be submitted?Question: The Skilled Nursing Facility Quality Reporting Program (SNF QRP) Data Validation Audit notification letter requested Admission and Discharge assessments. What assessments should be submitted? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-MT: On the …
- TIP: ABN Form Expires Jan. 31, 2026The Advanced Beneficiary Notice of Noncoverage (ABN), form CMS-R-131, is used by nursing facilities when Medicare Part B services are ending and the resident does not agree with the decision. The current form, posted on …
- CMS: Impact of Combined Assessments on SNF APU for SNF QRPImpact of Combined Assessments on SNF APU: How Medicare 5-Day and PPS Discharge Combined Assessments Affect Your Facility’s APU Calculation The Centers for Medicare & Medicaid Services (CMS) has released a one-page resource for SNF …
- CMS FY 2025 Improper PaymentsKey report excerpts re: SNFs: Within the Traditional Medicare program, reducing improper payments remains a challenge. The improper payment rate reported in FY 2024, 7.66 percent, has not decreased from the rates reported in FYs …
- Why Directors of Nursing Services Must Be Well-Versed in PDPM and How to Ensure Documentation AccuracyIn today’s skilled nursing facility (SNF) landscape, the director of nursing services (DNS) is critical not only in overseeing resident care but also in supporting the organization’s financial stability and regulatory compliance. Both goals require …
- Q&A: When a resident changes payers from Medicare Advantage to Traditional Medicare, are the Medicare Advantage days subtracted from the Medicare 100-day benefit period?Question: When a resident changes payers from Medicare Advantage to Traditional Medicare, are the Medicare Advantage days subtracted from the Medicare 100-day benefit period? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: Yes, days …
- TIP: Consolidated Billing Updates for 2026Consolidated billing specifies that the SNF is the responsible party for the billing of the entire package of care the resident receives during a covered Part A SNF stay, as well as identifies a limited …
- SNF QRP/SNF VBP: CMS Video Offers MDS Data Validation Process OverviewThe Centers for Medicare & Medicaid Services (CMS) is offering a recorded presentation which describes the new data validation process. This training will support facilities in understanding the purpose and structure of the data validation …
- Consolidated Billing HCPCS Code List Update: 2026 Part A MAC UpdateADD – EFFECTIVE 01/01/2026 Major Category I. B. – Cardiac Catheterization Major Category III. A. – Chemotherapy Major Category III. C. -Radioisotopes and their Administration TERMINATE – EFFECTIVE 01/01/2026 Major Category III. A. – Chemotherapy …
- FY 2026 ICD-10-CM Code Updates Effective April 1, 2026These files include updates for FY 2026. Use these codes for discharges occurring from April 1, 2026 – September 30, 2026, and for patient encounters occurring from April 1, 2026– September 30, 2026. https://www.cms.gov/medicare/coding-billing/icd-10-codes
- Physician Certification TrackerThe AAPACN Physician Certification Tracker tool helps nurse assessment coordinators track physician certification due dates by calculating required timeframes based on user-entered data and displaying upcoming and overdue certifications to support compliance. The accuracy of …
- SNF QRP and SNF VBP MDS Data Validation Program FAQs UpdatedOverview What is the SNF Validation Program? The SNF Validation Program is an audit-driven initiative aimed at evaluating the accuracy of quality measure data elements derived from the Minimum Data Set (MDS), which are used …
- SNF ABN: When to Use This Medicare Beneficiary Notice and WhyIn this LTC NAC Chat podcast episode, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN discuss when …
- Q&A: If a resident on Medicare Part A admits and discharges to home on the same day, can we bill Medicare for that day?Question: If a resident on Medicare Part A admits and discharges to home on the same day, can we bill Medicare for that day? Answer from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: …
- Simplifying the SNF ABN: Helping Residents Understand Their OptionsWhen a resident’s Medicare Part A skilled stay ends, two types of resident notification processes may be required under the Beneficiary Notices Initiative: the standard denial process and the expedited appeal process. In the standard …
- Q&A: Can we still use dementia as a primary diagnosis for our long-term residents?Question: Can we still use dementia as a primary diagnosis for our long-term residents? Our facility was recently told we can no longer use the dementia diagnosis (F03.90) although it maps to medical management? Answer …
- Part B Therapy Transmittals: 2026 Annual Update to the Therapy Code List and Per-Beneficiary ThresholdsImplementation Date 2026-01-05 CR # 14250 Publication # 100-04 Transmittal Year 2025 Downloads
- 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 …
- OIG: First SNF PDPM Audit ReportNearly All Skilled Nursing Services Provided by Pinnacle Multicare Nursing and Rehabilitation Center Did Not Meet Medicare Payment Requirements Issued on 11/14/2025 | Posted on 11/18/2025 | Report number: A-02-22-01017 Report Materials Why OIG Did This Audit What OIG Found What …
- Updated FY 2028 SNF VBP Performance StandardsThis communication pertains to the Fiscal Year (FY) 2028 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program performance standards for the Number of Hospitalizations per 1,000 Long Stay Resident Days (Long Stay Hospitalization) measure which …
- Q&A: A resident was skilled under Medicare Part A and exhausted benefits. We completed a Significant Change in Status Assessment to capture the improvement before the end of the stay. Should I have completed an IPA or something else with the significant change MDS?Question: A resident was skilled under Medicare Part A and exhausted benefits. We completed a Significant Change in Status Assessment to capture the improvement before the end of the stay. Should I have completed an …
- Back to PDPM Basics – Part 5: The NTA ComponentThe Non-Therapy Ancillary (NTA) component of the Patient-Driven Payment Model (PDPM) accounts for the medical complexity and resource-intensive services provided to residents in nursing facilities. This component is calculated using a combination of clinical diagnoses, …
- 2026 Medicare Parts A & B Premiums and DeductiblesOn November 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released the 2026 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2026 Medicare Part D …
- CY 2026 Medicare Physician Fee Schedule Final RuleThe Centers for Medicare & Medicaid Services (CMS) is increasing quality of care for Medicare beneficiaries while significantly reducing unnecessary spending and promoting payment accuracy. The calendar year (CY) 2026 Medicare Physician Fee Schedule (PFS) final rule advances primary …
- Q&A: Can the physician certification be met through a detailed order versus a separate certification form?Question: Can the physician certification be met through a detailed order versus a separate certification form? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-MT: CMS does not mandate a specific form or format, but …
- Q&A: We have a resident that had a qualifying hospital stay (QHS), then went to an LTACH for more than 30 days. Can the resident utilize their Medicare benefits since the transfer from acute hospital to SNF is more than 30 days?Question: We have a resident that had a qualifying hospital stay (QHS), then went to a long-term acute care hospital (LTACH) for more than 30 days. Can the resident still utilize their Medicare benefits in …
- Back to PDPM Basics – Part 4: The Nursing Component – Clinically Complex, Behavioral Symptoms and Cognitive Performance, and Reduced Physical FunctionThe nursing component of the Patient-Driven Payment Model (PDPM) may appear straightforward: calculate a section GG Nursing Function Score and assign the resident to one of six nursing categories. But accuracy relies on a detailed …
- ICD-10-CM Coding Convention Terminology Quick Reference GuideThe ICD-10-CM Coding Convention Terminology Quick Reference Guide provides a concise reference to key ICD-10-CM coding terminology and conventions for long-term care nurse assessment coordinators and coders. This guide simplifies complex terms and coding rules …
- PDPM Grouper JAR Package V2.4000This release was updated to support FY2026 ICD-10 codes which are used with MDS assessments with a target date on or after October 1, 2025. As part of this release, 487 clinical category mappings were added, …
- SNF QRP Measure Calculations and Reporting User’s Manual V7.0, Change Table, Risk Adjustment and Imputation Appendix Files, and HCC ICD-10 CrosswalksThe Skilled Nursing Facility Quality Reporting Program (SNF QRP) Measure Calculations and Reporting User’s Manual v7.0 and accompanying files are now available. These materials serve as an update to the specifications used to calculate quality measures that …
- MDS Item J2100 Feeds Into PDPM: Learn What’s at Stake and How to Boost AccuracyMDS item J2100 (Did the Resident Have a Major Surgical Procedure During the Prior Inpatient Hospital Stay That Requires Active Care During the SNF Stay?) is the gateway question for receiving enhanced reimbursement in the …
- Back to PDPM Basics – Part 3: The Nursing Component – Extensive Services and Special CareThe calculation for the nursing component of the Patient-Driven Payment Model (PDPM) can look deceptively simple. The two steps entail calculating a section GG nursing function score and then placing the resident into one of …
- IPA Quick Calculators – Urban and RuralWhen a resident’s condition changes during the Medicare Part A stay, the facility team must decide if an Interim Payment Assessment (IPA) is indicated. The AAPACN IPA Quick Calculator interactive tool can help the team …
- 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 …
- FY 2028 (CY 2026 Data) SNF QRP Reporting Requirements and Data Submission DeadlinesSNF QRP Data Collection and Final Submission Deadlines The SNF QRP Data Collection and Final Submission Deadlines have been updated to provide the data collection time frames and final submission deadlines for the FY 2028 …
- FY 2027 (CY 2025 Data) Revised SNF QRP MDS Reporting Requirements and Data Submission DeadlinesSNF QRP Data Elements Used for Reporting Assessment-Based QMs and Standardized Patient Assessment Data Elements Affecting FY 2027 APU Determination and Data Collection and Final Submission Deadlines for FY 2027 posted The Skilled Nursing Facility …
- FY 2026 ICD-10 PDPM Mappings FileThis file can be used by NACs to determine how ICD-10-CM codes entered on the MDS “map” to PDPM payment components. https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf/patient-driven-model
- FY 2026 SNF QRP FAQsAn 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 …
- New AAPACN Education Program Spotlight: PDPM Documentation Essentials for the IDTIn this LTC NAC Chat podcast episode, Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, senior curriculum development specialist for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN, discuss AAPACN’s latest …
- PDPM HIPPS Code At-a-GlanceThe Patient-Driven Payment Model (PDPM) 5-Character HIPPS code can be difficult to decipher. The PDPM HIPPS Code At-a-Glance tool will help nurse assessment coordinators quickly identify the key elements impacting Medicare reimbursement. This AAPACN resource …
- FY 2026 SNF PPS Final Rule: Section R Removal Tops the List of ChangesMDS section R (Health-Related Social Needs) is officially no more. The big news for nurse assessment coordinators (NACs) in the Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) and Consolidated Billing Final Rule for …
- FY 2026 SNF PPS Final Rule: Summary of Responses to AAPACN’s CommentsThe Centers for Medicare & Medicaid Services (CMS) released the Final Rule for the fiscal year (FY) 2026 Skilled Nursing Facility Prospective Payment System (SNF PPS), addressing several key recommendations submitted by the American Association …
- Back to PDPM Basics – Part 2: The SLP ComponentSince the implementation of the Patient-Driven Payment Model (PDPM), nursing facilities have had to take a more nuanced approach to how a resident’s needs are assessed and documented. As discussed in part 1 of this …
- FY 2026 SNF VBP ResourcesFrom https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing From https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing/confidential-feedback-reporting-review-and-corrections From https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing/scoring-methodology-payment-adjustment
- FY 2026 ICD-10-CM Code Updates and Coding Guidelines for Oct. 1, 2025 From CMS/CDCCDC announces new ICD-10-CM codes effective October 1, 2025. The October 1, 2025 diagnosis code update files are now available. Use these files for discharges occurring from October 1, 2025 – September 30, 2026, and for …
- FY 2026 SNF PPS Final Rule: More Money and Consistency, Less BurdenThe Centers for Medicare & Medicaid Services (CMS) did not propose any changes to the previously adopted quality measure (QM) sets for either the Skilled Nursing Facility Quality Reporting Program (SNF QRP) or the Skilled …
- FY 2026 Final Rule ICD-10 Mapping File, Wage Index File, and Case-Mix RatesRegulation No. CMS-1827-F Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026; Final Rule Year 2026 Publication Date 2025-08-04 This rule …
- FY 2026 SNF PPS Final Rule PostedOn July 31, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a final rule for updates to Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility Prospective Payment …
- Back to PDPM Basics – Part 1: The PT and OT ComponentsIn skilled nursing facilities (SNFs), staff members often find the Patient-Driven Payment Model (PDPM) process complex and unfamiliar, especially when determining how Medicare (and, in many states, Medicaid) payment is calculated. PDPM is based on …
- Myers and Stauffer Medicaid LinksMyers and Stauffer provides documentation resources and training opportunities for several state Medicaid programs. Learn more below. State Clients Alabama Iowa North Carolina Arkansas Kentucky Ohio California Louisiana Oregon Colorado Maryland Tennessee Connecticut Minnesota Texas …
- Q&A: Did this resident achieve a 60-day break in skilled services when a nurse assisted with tube feedings at the assisted living facility?Question: A resident previously exhausted his 100 days of Medicare for a new feeding tube. He was discharged to an assisted living facility (ALF) for more than 60 days where an licensed practical nurse (LPN) …
- TIP: New Non-Pressure Chronic Ulcer Codes Effective Oct. 1, 2025The Centers for Disease Control and Prevention (CDC) recently released the updated codes for fiscal year (FY) 2026. These updates include the addition of the following locations to the category L98.4, non-pressure chronic ulcer of …
- Q&A: Can Z codes be used as the admitting diagnosis on the claim?Question: Can Z codes be used as the admitting diagnosis on the claim? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC: Admission Diagnosis codes (Field Locator 69 on the claim) should be the code …
- Ethics in Medicare Part A Coverage in Skilled Nursing FacilitiesNavigating Medicare Part A coverage in skilled nursing facilities (SNFs) is a matter of regulatory compliance. But it’s also a daily ethical test for facility staff and administrators. In many ways it depends on the …
- Know the Rules, Win the Fight: Inside SNF Medicare AppealsIn this LTC NAC Chat podcast episode, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN, discuss the …
- SNF VBP Reminder: Performance-Period MDS Data Collection Is Now OngoingIn the Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) and Consolidated Billing Proposed Rule for Fiscal Year (FY) 2026, the Centers for Medicare & Medicaid Services (CMS) does not reveal any firm proposals …
- AAPACN Responds: FY 2026 SNF PPS Proposed RuleEvery spring, the American Association of Post-Acute Care Nursing (AAPACN) anticipates the Skilled Nursing Facility Prospective Payment System (SNF PPS) proposed rule. The Centers for Medicare & Medicaid Services (CMS) provides a 60-day comment period. …
- 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. PAC-SNF-QuickReferenceGuide-20250508 (PDF) From https://www.cms.gov/medicare/quality/snf-quality-reporting-program/submission-deadlines
- ICD-10-CM Diagnosis SequencingIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN, discuss the sequencing of ICD-10-CM diagnosis coding. Additional …
- TIP: SNF Value-Based Purchasing Fact Sheets ReleasedThe Centers for Medicare & Medicaid Services (CMS) recently released the FY 2026 Skilled Nursing Facility Value-Based Purchasing (VBP) fact sheet. This fact sheet details the program, measures used, case-minimums, the process for making correction, …
- SNF QRP Again Takes Center-Stage in the FY 2026 SNF PPS Proposed RuleIn the Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) and Consolidated Billing Proposed Rule for Fiscal Year (FY) 2026, officially published on April 30, 2025, the Centers for Medicare & Medicaid Services (CMS) …
- Deep Dive into ICD-10-CM: Diagnosis Sequencing GuidelinesThe International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code assignment continues to be a bit of an enigma in the long-term care setting. Members regularly ask questions about ICD-10-CM coding in AAPACN’s online …
- FY 2026 SNF VBP Program Fact Sheet and Incentive Payment Multiplier Calculation InfographicFY 2026 SNF VBP Program Fact Sheet (PDF) From https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing (also updated with FY 2026 information) SNF VBP Program: FY 2026 Incentive Payment Multiplier Calculation Infographic (PDF). From https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing/scoring-methodology-payment-adjustment
- SNF VBP QMs: What’s Coming Online to Impact Payment—and What’s ProposedThe Centers for Medicare & Medicaid Services (CMS) does not propose any new quality measures (QMs) for the pay-for-performance Skilled Nursing Value-Based Purchasing program (SNF VBP) in the Medicare Skilled Nursing Facility Prospective Payment System …
- Q&A: Is a Part A PPS Discharge assessment required if the resident exhausted the 100-day benefit?Question: Is a Part A PPS Discharge assessment required if the resident exhausted the 100-day benefit? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: Yes, the Part A PPS Discharge MUST be completed when …
- PDPM Audit by MDS SectionMost methods for auditing Patient-Driven Payment Model (PDPM) reimbursement focus on impacts to the HIPPS code. However, AAPACN’s PDPM Audit by MDS Section tool uses an approach that can result in identifying missed opportunities for …
- Follow-Up Answers to Q&A from Beneficiary Notices Jan. 30, 2025, AAPACN WebinarIn this podcast, Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, senior curriculum development specialist for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist for AAPACN, address some of the questions that were …
- Compliance in Diagnosis Selection for Skilled RehabilitationFor skilled nursing facilities (SNFs), diagnosis selection and accurate ICD-10-CM coding are essential for both quality resident care and compliance with regulations. For therapists providing skilled rehabilitation services, the ability to choose the correct diagnosis …
- A New Method for Auditing PDPMIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, senior curriculum development specialist with AAPACN, discuss a new method for auditing the …
- PDPM Overview for Supporting SNF StaffThe Centers for Medicare & Medicaid Services (CMS) implemented the Patient-Driven Payment Model (PDPM) in October 2019 for residents receiving Medicare Part A coverage in the skilled nursing facility (SNF). PDPM replaced the previous legacy …
- NOMNC and DENC: New Forms Must Be Used Starting Jan. 1, 2025; Different Start Date for DENC Only for Medicare AdvantageFFS & MA NOMNC/DENC What’s New 11/18/2024: New NOMNC and DENC for Original Medicare and Medicare Advantage The Office of Management and Budget (OMB) has approved a revised Notice of Medicare Non-Coverage (NOMNC / CMS-10123) …
- Residents on Part B Therapy? Provide Beneficiary Notices to Avoid a Financial HitNurse assessment coordinators (NACs) who manage Medicare services typically are at least familiar enough with the beneficiary notice requirements that skilled nursing facilities (SNFs) must meet under fee-for-service (FFS) Medicare Part A to monitor those …
- SNF PPS MedPAC Payment Basics Fact Sheet / Educational ToolUpdated November 2025 Skilled nursing facility services payment system Additional payment basics here: https://www.medpac.gov/document-type/payment-basic/
- OIG: Nursing Facility Industry Segment-Specific Compliance Program GuidanceFrom https://oig.hhs.gov/compliance/nursing-facility-icpg/ The Nursing Facility ICPG—together with OIG’s General Compliance Program Guidance (GCPG) that applies to all individuals and entities involved in the health care industry—serves as OIG’s updated and centralized source of voluntary compliance program guidance for …
- SNF ABN Update: What Changed and How to Keep the Process Running SmoothlyEffective Oct. 31, 2024, skilled nursing facilities (SNFs) now are required to use an updated Skilled Nursing Facility Advance Beneficiary Notice of Noncoverage (SNF ABN), also known as form CMS-10055, and the corresponding revised instructions …
- 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 …
- SNF QRP Quick Facts ToolsThe Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) has developed a variety of measures that use data from the MDS 3.0, Medicare Fee-for-Service Claims, and Centers for Disease Control and Prevention (CDC) National Healthcare …
- Updated Fiscal Years 2026 and 2027 SNF VBP Performance StandardsThis communication pertains to the Fiscal Year (FY) 2026 and FY 2027 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program performance standards for the Total Nursing Staff Turnover (Nursing Staff Turnover) measure which the Centers …
- Updates to ICD-10-CM Coding Guidelines: Key Revisions and Their ImplicationsThe International Classification of Diseases, Clinical Modification, 10th revision (ICD-10-CM), coding system is an essential tool needed to document and bill accurately for healthcare services in the long-term care (LTC) setting. Annual updates to both …
- Skilled Teaching and Training: Benefit From the Care Team’s ExpertiseLike care plan management and evaluation and observation and assessment of a resident’s condition, teaching and training activities are a core nonskilled component of resident care that can rise to the level of a skilled …