• Expedited Determinations Clarified

    By Caralyn Davis, Staff Writer - June 20, 2018

    Financial liability notification requirements are front and center right now thanks to the implementation of the revised Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) for traditional fee-for-service Medicare Part A skilled care. However, providers still have to fulfill the completely separate notification requirements of the two-stage expedited-determination process for residents who haven’t exhausted their benefits, but whose skilled care is about to end under Medicare Part A, Medicare Part B, or Medicare Advantage, says Stacy Baker, OTR/L, RAC-CT, director of audit services for Proactive Medical Review & Consulting in Evansville, IN. That point recently has been driven home in two ways:


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  • June 30 Deadline to Contest Inaccuracies in SNF QRP QM Provider Preview Reports (6/18)

    By CMS - June 07, 2018
    Skilled Nursing Facility Quality Reporting Program (SNF QRP) QM Provider Preview Reports have been updated and are now available. Providers have until June 30, 2018 to review their performance data prior to public display on the Nursing Home Compare site. Corrections to the underlying data will not be permitted during this time. However, providers can request a CMS review during the preview period if they believe their data scores displayed are inaccurate.
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  • PDPM At-a-Glance Tool

    By AANAC - May 15, 2018
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  • Q&A: Are providers allowed to “save” Medicare days for times when the resident has a more pressing skilled need?

    By Jennifer LaBay, RN, RAC-MT - May 14, 2018
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  • SNF VBP Minimum Eligible Stay Threshold Analysis (5/18)

    By CMS - May 07, 2018
    This memo provides analysis to inform the policy consideration of a minimum eligible stay threshold for the quality measure used in the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program— the Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM; NQF #2510). Specifically, we estimated the reliability of the measure as calculated for various eligible stay thresholds. We also identified the number of SNFs to which the scoring adjustment proposal would be applied at various thresholds.
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  • SNF/LTC ODF News: Section GG Takes Center Stage

    By Caralyn Davis, Staff Writer - May 03, 2018
    The functional scores used to classify patients under the proposed Patient-Driven Payment Model (PDPM) are based on Section GG of the MDS, pointed out officials with the Centers for Medicare & Medicaid Services (CMS) in a review of key aspects of the Fiscal Year (FY) 2019 Skilled Nursing Facility Prospective Payment System (SNF PPS) Proposed Rule during the May 1 Skilled Nursing Facility/Long-term Care Open Door Forum. This would mark a significant change for providers because the current RUG-IV model uses Section G, as did the Resident Classification System, Version I (RCS-I) model when CMS presented it last year as an initial possibility for revamping the case-mix classification system used in the SNF PPS.
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  • SNF QRP 4Q 2017 Help Desk FAQs (5/18)

    By CMS - May 02, 2018
    A new Question and Answer (Q+A) document is now available in the “Downloads” section of the SNF Quality Reporting Program FAQs webpage. The Q+A document reflects frequently asked questions that were received by the SNF QRP Help Desk during the fourth quarter (October - December) of 2017.
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  • May 15 SNF QRP Data Submission Deadline: Do These Final Checks

    By Caralyn Davis, Staff Writer - May 01, 2018

    May 15 is a big deadline for the Skilled Nursing Facility Quality Reporting Program (SNF QRP). “According to the Centers for Medicare & Medicaid Services (CMS), this is our last opportunity to do a correction for an entire year’s worth of MDS data,” points out Carol Maher, RN-BC, RAC-MT, CPC, director of education for Hansen, Hunter & Co. PC in Vancouver, WA.

    “Moving forward, we will only have the opportunity to correct MDSs with errors related to SNF QRP for one quarter at a time,” says Maher. “There won’t be this allowance to review and correct for a whole year.”

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  • SNF PPS: CMS Proposes Big Changes for Oct. 1, 2019

    By Caralyn Davis, Staff Writer - May 01, 2018

    On April 27, 2018, the Centers for Medicare & Medicaid Services (CMS) proposed to launch a revised case-mix classification model called the Patient-Driven Payment Model (PDPM) effective Oct. 1, 2019, (i.e., starting with FY 2020) that could radically re-imagine the job of the nurse assessment coordinator (NAC). The PDPM makes the use of therapy minutes to classify a resident for payment purposes obsolete, significantly alters the PPS assessment schedule, and institutes a variable per-diem payment adjustment schedule for the first time in SNF PPS history, according to the Fiscal Year (FY) 2019 Skilled Nursing Facility Prospective Payment System (SNF PPS) Proposed Rule.

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  • Proposed SNF Patient-Driven Payment Model (PDPM) for Medicare Part A: Technical Resources (4/18)

    By CMS - April 27, 2018

    In May 2017, CMS released an Advanced Notice of Proposed Rulemaking (ANPRM) which outlined a new case-mix model, the Resident Classification System, Version I (RCS-I), that would be used to replace the existing RUG-IV case-mix model, used to classify residents in a covered Part A stay into payment groups under the SNF PPS. Since the ANPRM, we continued our stakeholder engagement efforts to address the concerns and questions raised by commenters with RCS-I. This resulted in significant changes to the RCS-I model, which have prompted us to rename the proposed model discussed in the FY 2019 SNF PPS Notice of Proposed Rulemaking (NPRM) the SNF Patient Driven Payment Model (PDPM). 

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  • Q&A: Is section GG required to be completed for both traditional Medicare Part A residents and Medicare Advantage plan residents?

    By Carol Maher, RN-BC, CPC, RAC-MT - April 18, 2018
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  • TIP: Beneficiary notices and hospice election: Do you know the requirements?

    By AANAC - April 04, 2018
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  • SNF VBP MLN Matters Article Explaining Program Updated (3/18)

    By MLN Matters - March 30, 2018
    Special Edition article SE18003 informs providers about the SNF Value-Based Purchasing (VBP) Program. The VBP Program is one of many VBP programs that aim to reward quality and improve health care. Beginning October 1, 2018, SNFs will have an opportunity to receive incentive payments based on their performance in the program.
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  • Why the Right ICD-10 CM Diagnosis Makes the Difference for Skilled Nursing Facilities

    By Staff Writer - March 21, 2018
    The incorrect medical diagnosis/ICD-10-CM code has negative repercussions not only for care but also for billing claims. This is especially true for skilled nursing facilities (SNFs), as they move from a volume-based to a value-based reimbursement system. As the Centers for Medicare & Medicaid Services (CMS) rolls out new programs that measure and monitor quality of care, including the SNF Quality Reporting Program (QRP) and SNF Value-Based Purchasing (VBP) program, the correct ICD-10-CM codes are more important than ever. Since Quality Measures are risk adjusted based on multiple factors, including established diagnosis, it is critical for ICD-10 codes to be accurately collected and reported. Here’s how it all connects.
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  • TIP: Act Now On QRP Deadlines

    By AANAC - March 21, 2018
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