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.
- Working With Medicare Advantage Plans: 10 Tips to Maximize ResultsMedicare Advantage enrollment continues to grow, representing 48 percent of eligible Medicare beneficiaries in 2022, according to the Aug. 25, 2022, issue brief, Medicare Advantage in 2022: Enrollment Update and Key Trends, from the Kaiser …
- TIP: CMS Posts Several Updated SNF QRP DocumentsThe Centers for Medicare & Medicaid Services (CMS) recently posted updated versions of the following Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) documents: The Fiscal Year (FY) 2023 SNF QRP Frequently Asked Questions (FAQs) …
- Q&A: Is this an interrupted stay?Question: Is this an interrupted stay? A resident newly admits to the facility on 9/21 on a Medicare Part A stay. On 9/23, the resident was sent to the emergency room and was admitted to …
- Q&A: We have a resident for whom we are completing an Interim Payment Assessment (IPA). Would we also need to complete a Significant Change in Status Assessment (SCSA) at the same time due to these changes?Question: We have a resident for whom we are completing an Interim Payment Assessment (IPA). Would we also need to complete a Significant Change in Status Assessment (SCSA) at the same time due to these …
- Oct. 19 CDC NHSN Webinar on Reporting Healthcare Personnel Flu Vaccination Data for SNF QRP: Registration RequiredReplay of Annual Influenza Updates for Long term Care Facilities Description REPLAY of the training held September 27, 2022 for facilities enrolled in the National Healthcare Safety Network (NHSN) Healthcare Personnel Safety (HPS) Component can …
- CMS: 2023 Medicare Parts A & B Premiums and Deductibles (9/22)On September 27, 2022, the Centers for Medicare & Medicaid Services (CMS) released the 2023 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2023 Medicare Part D …
- CMS to End RUGs Support for Medicaid Case-Mix on Oct. 1, 2023; Gives States Guidance re: PDPM (9/22)Guidance on Nursing Facility State Plan Payment and Upper Payment Limit Approaches in Medicaid Relying on the Medicare Patient-Driven Payment Model (SMD 22-005) “As stated at the beginning of this letter, CMS will no longer …
- jRAVEN Free MDS Software Updated to v1.8.2 (9/22)The Resident Assessment Validation and Entry System (jRAVEN) was developed by the Centers for Medicare & Medicaid Services (CMS). jRAVEN is a free Java based software application which provides an option for facilities to collect …
- FY 2025 (Calendar Year 2023) SNF QRP APU Table for the MDS Data Submission ThresholdA table providing the data elements that will be required to meet the Annual Payment Update (APU) minimum data completion threshold for the Fiscal Year (FY) 2025 Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) …
- FY 2025 (Calendar 2023) SNF QRP Data Collection and Final Submission Deadlines (9/22)A table providing the data collection time frames and final submission deadlines for the Fiscal Year (FY) 2025 Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) is available. Note that the NHSN measure, Influenza Vaccination …
- FY 2024 (Calendar 2022) SNF QRP Data Collection and Final Submission Deadlines UPDATED (9/22)An updated table providing the data collection time frames and final submission deadlines for the Fiscal Year (FY) 2024 Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) is available. The FY 2024 update adds in …
- FY 2023 SNF QRP FAQs (9/22)An update to the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Frequently Asked Questions (FAQs) document is now available. This document has been updated to reflect the finalized policies for the SNF QRP in …
- ICD-10 Coding: Keys to the Achieving the Highest SpecificityLike the Fiscal Year (FY) 2022 ICD-10-CM Official Guidelines for Coding and Reporting, the general coding guidelines in the FY 2023 ICD-10 Official Coding Guidelines instruct coders that “diagnosis codes are to be used and …
- PDPM At-a-Glance ToolThe PDPM At-a-Glance tool breaks down the complex methodology of each component used in the Patient-Driven Payment Model—physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), non-therapy ancillaries (NTA), and nursing. This tool provides key …
- Medicare Parts A & B Appeals Process: How the Five Levels of Appeal Work (9/22)This booklet informs health care providers about Medicare’s 5 appeal levels in Fee-for-Service (FFS) (Original Medicare) Parts A and B and includes resources on related topics. It also describes how providers, physicians, and suppliers apply …
- PDPM Grouper Updated (9/22)An updated version of the Patient Driven Payment Model (PDPM) Grouper V2.1000 has been posted. This update is just a documentation update to clarify the following: Jars are packaged differently (snf-x.x.x-jar-with-dependencies removed). Instead, jars in …
- HHS ASPE: State Use of Value-Based Payment in Nursing Facilities Issue Brief (9/22)Payers across the health care spectrum have begun transitioning from paying for quantity toward paying for quality. These value-based payment (VBP) programs vary in scope and focus, but generally share the goals of improving cost-savings …
- MLN Connects: Updated COVID-19 Vaccines Available at No Cost (9/22)The Department of Health & Human Services (HHS), through CMS announced that people with Medicare, Medicaid, Children’s Health Insurance Program coverage, private insurance coverage, or no health coverage can get COVID-19 vaccines, including the updated Moderna …
- SNF VBP Online Resources: New Updates for FY 2023 (9/22)CMS has an online home for the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program that offers multiple resources explaining how the program works. Landing page: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/SNF-VBP/SNF-VBP-Page.html Measure Scoring Methodology & Payment Adjustment Confidential Feedback …
- HHS Joins CFPB to Protect Nursing Home Residents and Their Caregivers from Illegal Debt Collection Practices (9/22)In Joint Letter with CFPB, HHS Stresses to Nursing Homes and Debt Collectors Prohibition on Requiring Caregivers to Assume Responsibility for Cost of Resident’s Care The U.S. Department of Health and Human Services (HHS), through …
- SNF QRP Measure Calculations and Reporting User’s Manual Plus Risk Adjustment File and Crosswalks – Updated (9/22)SNF QRP Quality Measure Calculations and Reporting User’s Manual V4.0, Change Table, Risk Adjustment Appendix File, and HCC ICD-10 Crosswalks The Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Quality Measure Calculations and Reporting User’s …
- CMS Nursing Home Data Sets Updated (9/22)Five-Star, NHQI, SNF QRP, SNF VBP, PBJ data COVID-19 Vaccination Rates – State and National Averages State and National averages for facility resident and healthcare personnel COVID-19 vaccination rates. Data are presented as one row …
- FY 2023 – 2024 Parity Recalibrations Demand a Back-to-Basics ApproachFee-for-service Medicare Part A reimbursement is under significant pressure over the next two fiscal years due to a parity adjustment recalibration that will reduce aggregate payments by $780 million just in FY 2023 (Oct. 1, …
- Is Your Facility’s Medicare Reimbursement Faucet Leaking? 3 Areas to Check for RepairsNurse assessment coordinators’ (NACs’) actions drive the Medicare reimbursement that a skilled nursing facility (SNF) receives for the care it provides. NACs oversee the process of assessing residents, developing documentation, and submitting the MDS—all of …
- TIP: CMS Provides More Information on the iQIES Security OfficialCenters for Medicare & Medicaid Services (CMS) recently announced onboarding training for facility security officials for the iQIES. CMS posted the following materials to improve understanding of the onboarding process and a job aid for …
- 2022 Five-Star and Quality Measure ChangesIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN, and Jessie McGill, RN, RAC-MT, RAC-MTA, curriculum development specialist with AAPACN, talk about recent changes …
- Q&A: Can Z codes be used as the primary diagnosis?Question: I was told that, as of the April update of this year, we are no longer allowed to use Z codes as the primary diagnosis. Is this true? Answer by Carol Maher, RN-BC, RAC-MTA, …
- PBJ Takes Center-Stage: What the DNS Needs to KnowThe Payroll-Based Journal (PBJ) electronic staffing data system remains a little bit of a mystery to many directors of nursing services (DNSs), but the Centers for Medicare & Medicaid Services (CMS) is going all-in on …
- TIP: Transition to iQIES Will Require a Security OfficialThe Centers for Medicare & Medicaid Services (CMS) will be transitioning nursing homes to the Internet Quality Improvement and Evaluation System (iQIES) in the coming months. This system consolidates and replaces the Quality Improvement and …
- CMS Encourages States to Use Medicaid Payments to Nursing Homes to Drive Better Health Outcomes for Residents, Improve Staffing (8/22)CMS outlines actions for states to improve safety and quality of care for residents The Centers for Medicare & Medicaid Services (CMS) issued an informational bulletin detailing actions that states can take using existing Medicaid …
- FY 2023 ICD-10 codes for MDS V3.00.1 (FINAL) Data Submission Specs (8/22)An updated PDPM ICD Codes database for the MDS V3.00.1 (FINAL) Data Specifications is now available for download. The database contains two new tables. The table pdpm_icd_codes_FY2023 contains the allowed FY2023 codes for I0020B, while table …
- CMS: Part A Three-Day Hospital Stay Waiver Will Definitely End at COVID-19 PHE End (8/22)CMS has issued a new fact sheet with information about which COVID-19 Public Health Emergency (PHE) waivers and flexibilities have already been terminated, have been made permanent, or will end at the end of the …
- COVID-19 Emergency Declaration Blanket Waivers List Updated to Roadmap PHE End (8/22)You can read the blanket waivers for COVID-19 in the List of Blanket Waivers (PDF) UPDATED (8/18/2022). Unless otherwise noted, these waivers will terminate at the end of the COVID-19 public health emergency (PHE) From https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page
- Get Ready: SNF QRP Data Submission Requirements Are IncreasingWhile key details are still pending, the Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule makes clear that meeting the reporting requirements of the Skilled Nursing Facility Quality Reporting …
- Q&A: Our billing department is being told by a third party that if we code any “unspecified” diagnoses in I8000, Medicare will deny it. Is this accurate?Question: Our billing department is being told by a third party that if we code any “unspecified” diagnoses in I8000, Medicare will deny it. Is this accurate? Answered by Jeff Taylor: This is absolutely false. …
- SNF QRP Provider Threshold Report Unavailable (8/22)The SNF Provider Threshold Report in the ‘SNF Quality Reporting Program’ report category in the CASPER Reporting application is unavailable. An issue has been identified with the display of HCP COVID-19 Vaccine data submission results. …
- Falsified MDSs and Nurse Staffing Hours the Focus of PA Indictments (8/22)PITTSBURGH – Five individuals and two for-profit skilled nursing facilities in Southwestern Pennsylvania have been indicted by federal grand jury in Pittsburgh on charges of conspiracy to defraud the United States and related health care …
- At-a-Glance QM, QRP, and VBP ToolWith so many Quality Measures originating from three different payment initiative programs, it’s a lot to keep track of. AAPACN’s At-a-Glance QM, QRP, and VBP tool organizes all of the measures for you. This tool has been …
- COVID-19 Medicare FAQs Updated (8/22)These address issues related to SNF consolidated billing, telehealth, and other Medicare coverage and payment issues. Frequently Asked Questions to Assist Medicare Providers (PDF) UPDATED (8/16/22 Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction (PDF) (2/16/21) Frequently Asked …
- CMS Softens the Blow of the Parity Recalibration, but Change Is Coming QuicklyThe Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule may not “turn that frown upside down” as the popular saying goes, but it does give SNFs—and in some cases …
- Q&A: Can a resident be skilled for Medicare Part A and receive hospice care?Question: Can a resident be skilled for Medicare Part A and receive hospice care? Answer by Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: In order to cover someone on hospice for Medicare A, the …
- FY 2023 PDPM ICD-10 Mappings File (8/22)ICD-10-CM related mappings for the purposes of resident classification under the Patient-Driven Payment Model (PDPM) for Medicare Part A SNF stays. Updated all three mappings to FY2023 code list. Reflected all changes finalized in the …
- FY 2023 SNF PPS Final Wage Index Tables (8/22)CMS-1765-F Wage Index Tables for FY 2023 – Final (ZIP) From https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex
- FY 2023 ICD-10-CM Codes and Official Coding Guidelines Effective Oct. 1, 2022 (8/22)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 …
- FY 2023 SNF PPS Final Rule Press Release and Fact Sheet From CMS (7/22)Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2023; etc. PDF 348 Pages (962 KB)Permalink Press release: CMS Acts to Improve the …
- ICD-10-CM Codes: Use of Unspecified Codes Resulting in Medicare DenialsIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN, Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN, and Carol Maher, …
- Solve the Mystery of the Interrupted StayAh, the great mysteries of life. Which came first, the chicken or the egg? Is there intelligent life on other planets? Where do all the missing socks go? And of course, the enduring mystery: what …
- TIP: SNF QRP Provider Preview Reports AvailableThe Skilled Nursing Facility (SNF) Provider Preview Reports, which contain the performance scores of the SNF Quality Reporting Program (QRP) measures, were released in late July. These measures will be publicly reported on Care Compare …
- Q&A: Can a resident be skilled for Medicare Part A if they are receiving an oral antibiotic for an infection, such as pneumonia or cellulitis? Question: Can a resident be skilled for Medicare Part A if they are receiving an oral antibiotic for an infection, such as pneumonia or cellulitis? Answered by Jeff Taylor: Here’s a link to the Medicare …
- Interrupted Stay Tracker ToolFor Medicare residents, nurse assessment coordinators (NACs) need to determine whether an interrupted stay has occurred and ensure that the correct MDS assessments, both OBRA and PPS, are in place. AAPACN’s Interrupted Stay Tracker tool …
- Interrupted Stay Policy Quick GuideThe interrupted stay policy designates that a Medicare stay is considered a continuous stay when it is interrupted by less than three non-covered days. AAPACN’s Interrupted Stay Policy Quick Guide provides the key facts for …
- Interrupted Stay Flow ChartDetermining whether an interrupted stay has occurred can be a challenge, especially when so many different factors must be considered. AAPACN’s enhanced Interrupted Stay Flow Chart will help nurse assessment coordinators (NACs) navigate different scenarios to …
- Medicare A2400C Algorithm with the NPE and Interrupted StayAAPACN has adapted the A2400C flow chart from section A of the RAI User’s Manual to show how A2400C impacts how the nurse assessment coordinator (NAC) schedules the PPS Part A Discharge assessment and how …
- COVID-19 Public Health Emergency (PHE) Renewal (7/22)Renewal of the Determination that a Public Health Emergency Exists Nationwide as the Result of the Continued Consequences of Coronavirus Disease 2019 (COVID-19) Pandemic COVID-19 National July 15, 2022
- Q&A: Are physician certifications required for Medicare Advantage patients?Question: Are physician certifications required for Medicare Advantage patients? Answered by Karen Bernius, PT, RAC-CTA: There are no federal requirements, but you do need to check with the specific HMO/Medicare Advantage plan. We have found …
- CMS Report to Congress: Unified Payment for Medicare-Covered Post-Acute Care (7/22)The unified approach to case-mix adjustment includes standardized patient assessment data collected by the four PAC providers. Unified PAC Report to Congress (PDF) | Unified PAC Report to Congress Appendices (ZIP) Section 2(b)(2)(A) of the Improving Post-Acute …
- Calendar Year 2023 Medicare Physician Fee Schedule Proposed Rule (7/22)CMS Proposes Physician Payment Rule to Expand Access to High-Quality Care On July 7, CMS issued the Calendar Year 2023 Physician Fee Schedule (PFS) proposed rule, which would significantly expand access to behavioral health services, …
- MedPAC June 2022 report on Medicare and the Healthcare Delivery System (6/22)The Medicare Payment Advisory Commission (MedPAC) releases its June 2022 Report to the Congress: Medicare and the Health Care Delivery System. Each June, as part of its mandate from the Congress, MedPAC reports on issues affecting the …
- AAPACN Responds to CMS’s Comment Request for FY 2023 SNF PPS Proposed RuleJessie McGill, RN, RAC-MT, RAC-MTA and Alexis Roam, MSN, RN-BC, DNS-CT, QCP The annual rulemaking process enables stakeholders to comment on proposals that will affect skilled nursing facilities (SNFs) throughout the next year. In early …
- TIP: CMS Releases Updated PBJ ManualThe Centers for Medicare & Medicaid Services (CMS) released the updated Version 2.6 Electronic Staffing Data Submission Payroll-Based Journal (PBJ) Long-Term Care Facility Policy Manual in June 2022. The update reinforces CMS’s message to validate …
- Quick Facts – SNF QRP Proposed Measure: Influenza Vaccination Coverage among Healthcare PersonnelThe Centers for Medicare & Medicaid Services (CMS) proposed a new Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) measure that will potentially be included in FY 2025 program year. The Influenza Vaccination Coverage Among …
- Q&A: A resident on Medicare Part A for skilled therapy could not participate with therapy for a few consecutive days due to a clinical condition. Can he remain on skilled care during those days?Question: A resident on Medicare Part A for skilled therapy could not participate with therapy for a few consecutive days because his Hemoglobin and Hematocrit were too low and he received blood transfusions. Will the …
- Medicare Part B Therapy Documentation Requirements MLN Fact Sheet (6/22)Complying with Outpatient Rehabilitation Therapy Documentation Requirements Fact Sheet ICN: MLN905365 Product Description: Learn how to correctly bill for outpatient Physical Therapy, Occupational Therapy, and Speech-Language Pathology services to avoid common billing errors when submitting claims to …
- Part A Physician Certs/Recerts: Don’t Strike Out on This Condition of PaymentPhysician certifications and recertifications are a technical requirement of payment (i.e., a condition of payment) under fee-for-service Medicare Part A. These certifications are needed to verify that a resident requires daily skilled care in a …
- Q&A: Should I complete an interim payment assessment (IPA) for a SNF resident who now tests positive for COVID and is newly receiving isolation for the active infection?Question: I have two residents in my facility that admitted skilled on Medicare Part A and they have since both tested positive for COVID-19. My administrator would like to claim the isolation days and has …
- Becoming a Fiscally Savvy DNS – Part 2: Budget, Revenue, and Five-Star RatingsWhen one considers financial management, thoughts usually go to managing expenses first, which part one of this series discussed. However, managing revenue, Five-Star ratings, and the budgeting process are equally important to keeping the nursing department and …
- CASPER Reporting User’s Guide for MDS Providers UPDATED (5/22)The CASPER Reporting User’s Guide for MDS Providers provides information and instructions pertaining to the CASPER Reporting application. This system enables users to connect electronically to the National Reporting Database. This guide is intended for …
- Updated MDS Item Set Proposed for FY 2024The last MDS item set update nurse assessment coordinators (NACs) had to prepare for was v1.17.1. When it went into effect Oct. 1, 2019, that version provided the changes needed to implement the Patient-Driven Payment …
- TIP: Don’t Use ICD-10-CM Code as Primary with “Disease Classified Elsewhere” or “Code First” InstructionsWhen determining the primary diagnosis for a resident, the coder must consider the guidance set forth in the ICD-10-CM Official Guidelines for Coding and Reporting for each fiscal year. One area that may cause confusion …
- 3 Things NACs Need to Know about the FY 2023 SNF PPS Proposed RuleIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN, and Jessie McGill, RN, RAC-MT, RAC-MTA, curriculum development specialist for AAPACN, discuss the recently released …
- Q&A: Does an inpatient rehab stay count toward a qualifying hospital stay for Medicare coverage?Question: We have a referral for a resident with Medicare Part A who has been in an inpatient rehab facility (IRF) for six weeks. Is the IRF still considered acute and can qualify for the …
- Q&A: A Medicare Part A resident was admitted to the hospital and returned to the SNF for a new Medicare stay. Does the diagnosis from the original stay need to be used or can this change?Question: A resident was Medicare Part A with a primary diagnosis of pneumonia. On day 15 of the stay, the resident was admitted to the hospital for five days for atrial fibrillation and hospital acquired …
- Q&A: How many days can a Medicare Part A resident be out on a therapeutic leave and be able to come back to the facility without it being considered an End of Stay?Question: How many days can a Medicare Part A resident be out on a therapeutic leave and be able to come back to the facility without it being considered an End of Stay? Answered by …
- TIP: CMS Asking for Comments on New SNF PPS Proposed RuleThe Centers for Medicare & Medicaid Services (CMS) released the Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) Proposed Rule earlier this month. CMS notes that this proposed rule would update “Payment …
- PDPM: Clearing Up Nursing Component Confusion – Part 5 – Behavioral Symptoms and Cognitive Performance and Reduced Physical FunctionEditor’s note: This is the fifth and final article in a series on the Patient Driven Payment Model (PDPM) categories for the nursing component, covering various missteps to avoid in PDPM calculation, as well as …
- Q&A: How are therapy services billed when a resident is admitted to the facility for skilled nursing only and hospital documentation recommended outpatient services at home for PT/OT?Question: We have a patient coming to us that the hospital rehab documented they are not appropriate for skilled rehab and recommended home with PT/OT outpatient. However, the physician documented a skilled nursing need to …
- Resident Cognitive Level Determination: For the SLP and Nursing Components Under PDPMIf the BIMS interview is not completed, the PDPM Cognitive Level will be used to determine cognitive impairment under the SLP and Nursing components of PDPM. AAPACN has updated its Resident Cognitive Level Determination Tool to help nurse …
- Highlights from CMS’s 2022 Updates AAPACN Conference SessionLast week, the AAPACN 2022 Conference was held in Las Vegas, bringing together nursing professionals for exceptional learning opportunities. One outstanding session occurred on Thursday, April 14, when representatives from the Centers for Medicare & …
- New Measures and New Rules Will Change the SNF VBP LandscapeWith the release of the Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) proposed rule, the Centers for Medicare & Medicaid Services (CMS) has signaled a significant commitment to pay-for-performance via …
- FY 2023 SNF PPS Proposed Rule Pushes SNFs Out of Emergency ModeWhile the COVID-19 public health emergency (PHE) put the brakes on many nursing home initiatives over the past two years, the Centers for Medicare & Medicaid Services (CMS) is ready to get back to business …
- SNF VBP: FY 2026 Program Year Proposed Nurse Staffing Measure Technical Specifications (4/22)Proposed Specifications for the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program: Total Nursing Hours per Resident Day Measure (PDF) From https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/SNF-VBP/Measure
- Meeting SNF QRP HCP COVID-19 Vaccine Data Submission Requirements? Find Out With This Update to SNF Provider Threshold Report (4/22)An updated version of the Skilled Nursing Facility (SNF) Provider Threshold Report (PTR) is now available. The PTR is a user-requested, on demand report which enables users to obtain the status of their data submission …
- SNF Q4FY21 PEPPER Available (4/22)The Q4FY21 release of the Skilled Nursing Facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through September 2021 is now available for download through the PEPPER Resources Portal. To obtain your SNF PEPPER, the Chief Executive Officer, President, Administrator, …
- Q&A: If a resident on a Medicare Part A stay goes on a leave of absence for two days, is it considered an interrupted stay? Question: We have a resident who is currently on Medicare Part A receiving skilled services for rehabilitation. His family would like to take him out for a leave of absence (LOA) from Thursday morning to …
- Q&A: When a resident is status-post surgery, would that be enough criteria to quality for skilled services?Question: When a resident is status-post surgery, would that be enough criteria to quality for skilled services? Answer from Jeff Taylor: It really depends on the resident’s condition and what services/cares they need. If the resident …
- SNF QRP Quick Reference Guide (4/22)An updated Quick Reference Guide is now available. The Quick Reference Guide provides high-level information on the SNF Quality Reporting Program, including frequently asked questions and helpful links. V2.0 was posted in early March. It …
- Definition and Uses of Health Insurance Prospective Payment System (HIPPS) Codes (4/22)CMS has updated the following document: Definition and Uses of HIPPS Codes (Updated 04/01/2022) (PDF) From https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes
- MedPAC March 2022 Report on Medicare Payment Policy (3/22)The Medicare Payment Advisory Commission (MedPAC) has released its March 2022 Report to the Congress: Medicare Payment Policy. The report includes MedPAC’s analyses of payment adequacy in traditional fee-for-service (FFS) Medicare and reviews the status of Medicare …
- PDPM: Clearing Up Nursing Component Confusion – Part 4 – Focus on Clinically ComplexEditor’s note: This is the fourth article in a series on the PDPM categories for the nursing component, covering various missteps to avoid in PDPM calculation, as well as essential coding tips. Part one focused …
- Accurate ICD-10 Coding Requires a Deeper DiveA nurse assessment coordinator (NAC) needs an ICD-10-CM diagnosis code for MDS section I (Active Diagnoses) or a Medicare claim. They enter the physician-documented, active diagnosis into a software tool or online lookup tool and …
- TIP: CMS Offers New PBJ Training and ResourcesCMS recently posted a one-page document that provides links to important Payroll-Based Journaling (PBJ) action items, including how to complete registration for staff, corporate, and third-party users, as well as data submission trainings and resources. …
- ICD-10 Diagnosis Coding for Skilled Nursing Facilities with Carol MaherIn this podcast, Amy Stewart, vice president of education and certification strategy for AAPACN, and Carol Maher, director of education for Hansen, Hunter & Co., discuss ICD-10 diagnosis coding for skilled nursing facilities.
- Frustrated by Managed Care Payment Denials? Learn to Spot Key LandminesMedicare Advantage (MA) plans, the most common type of Medicare managed care organizations, are an attractive option for healthy Medicare beneficiaries in the community because they often provide a range of supplemental benefits that aren’t …
- SNF PPS Web Pricer for FY 2020 – FY 2022 Available (3/22)The Skilled Nursing Facility (SNF) PPS Web Pricer is now available for Fiscal Years (FYs) 2020 through 2022. The new SNF Web Pricer can be accessed via the following link: https://webpricer.cms.gov/#/pricer/snf. For the best user experience, …
- PDPM: Clearing Up Nursing Component Confusion – Part Three – Focus on Special Care LowEditor’s note: This is the third article in a series on the PDPM categories for the nursing component, covering various missteps to avoid in PDPM calculation, as well as essential coding tips. Part one focused …
- Solving the IPA Mystery Can Help NACs Show Their WorthThe nurse assessment coordinator (NAC) is still commonly stereotyped as a paper pusher or desk nurse in some sectors of long-term care, but the Patient-Driven Payment Model (PDPM) in the Skilled Nursing Facility Prospective Payment …
- Q&A: Some members of my PDPM team feel that the diagnosis R27.8 “Other lack of coordination” should be used as the primary diagnosis. What kind of documentation would you need to be able to use this code?Question: Some members of my PDPM team feel that the diagnosis R27.8 “Other lack of coordination” should be used as the primary diagnosis. What kind of documentation would you need to be able to use …
- Evaluation of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents—Payment Reform Final Report (2/22)Latest Evaluation Report Two Pager: Final Annual Findings At-A-Glance Report (PDF) Final Annual Report (PDF) Appendices (PDF)
- The Substantial Impact of the PHQ-9Nearly two years into the COVID-19 public health emergency (PHE), nursing home staff continue to see its impact on all residents, not just those who have recovered from COVID-19. According to the CMS memorandum QSO-20-39-NH, CMS’s …
- SNF QRP COVID-19 Public Reporting Tip Sheet, 2nd Edition (1/22)The purpose of the Second Edition Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Public Reporting Tip Sheet is to help providers understand CMS’ public reporting approach to the SNF QRP to account for CMS quality data …