• PDPM At-a-Glance Tool

    By AANAC - April 24, 2019
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  • Proposed FY 2020 SNF QRP QM Data Specifications and SPADE MDS Items (4/19)

    By CMS - April 19, 2019

    Specifications for the quality measures and standardized patient assessment data elements for the SNF QRP as proposed in the FY 2020 SNF PPS Proposed Rule are now posted.

    In addition, the new and modified sections of the MDS, along with a change table, effective October 1, 2020 for the measures and standardized patient assessment data elements proposed for the SNF QRP in the FY 2020 SNF PPS Proposed Rule are available.

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  • At A Glance QM, QRP, and VBP Tool

    By AANAC - April 18, 2019
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  • FY 2021 SNF QRP Program Requirements Fact Sheet (4/19)

    By CMS - April 10, 2019
    The SNF QRP Requirements for the Fiscal Year 2021 Program Year Fact Sheet is now available for download on the SNF Quality Reporting Program Data Submission Deadlines webpage. This Fact Sheet contains information about requirements for the SNF QRP for the FY 2021 program year, which reflects data collected from 1/1/19–12/31/19.
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  • CMS SNF VBP FAQs UPDATED (4/19)

    By CMS - April 05, 2019

    Topics covered include:

      • What is the Skilled Nursing Facility Value-Based Purchasing Program?
      • What SNFs are included in the SNF VBP Program?
      • What measure is currently being used in the SNF VBP Program?
      • What is the difference between a planned readmission and an unplanned readmission?
      • When does the SNFRM 30-day period begin and end?
      • Are the measures in the SNF VBP Program the same as the measures in the SNF Quality Reporting Program (QRP) and on the Nursing Home Compare website?
      • How are performance scores calculated?
      • Will SNFs be able to calculate their achievement and improvement points?
      • How are incentive payments determined?
      • How will SNFs be notified of their performance in the Program?
      • What is Phase One of the Review and Corrections process?
      • How can I correct an error in my patient-level data?
      • What is Phase Two of the Review and Corrections process?
      • Where can I find more information or ask questions about the SNF VBP Program?
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  • SNF QRP Review and Correct Reports Now Available (4/19)

    By CMS - April 05, 2019

    The enhanced Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) review and correct reports are now available, on demand in the Certification and Survey Provider Enhanced Reporting (CASPER) application. In addition to enhanced sorting functionality, this report now includes patient level data and automated CSV file creation functionality that contains patient level results. Providers can access these reports by selecting the CASPER Reporting link on the “Welcome to the CMS QIES Systems for Providers” webpage.

    NOTE: You must log into the CMS Network using your CMSNet user ID and password in order to access the “Welcome to the CMS QIES Systems for Providers” webpage.

    In addition to the sorting enhancements and inclusion of resident level data, these reports:

    • Contain quality measure information at the facility level
    • Allow providers to obtain aggregate performance for the past four quarters (when data is available)
    • Include data submitted prior to the applicable quarterly data submission deadlines
    • Display whether the data correction period for a given CY quarter is “open” or “closed.
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  • May 7 - 8 SNF QRP CMS Training: Register for In-Person or Online Attendance (3/19)

    By CMS - March 21, 2019

    REGISTRATION OPEN – SNF QRP Provider In-Person Training Event, May 7 and 8, 2019

    The Centers for Medicare & Medicaid Services (CMS) will be hosting a 2-day Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) in-person ‘Train the Trainer’ event for providers on May 7 and 8, 2019, at the Sheraton Kansas City Hotel at Crown Center, 2345 McGee Street, Kansas City, MO 64108. This event will be open to all SNF providers, associations, and organizations.

    The primary focus of this 'Train-the-Trainer’ event will be to provide those responsible for training staff at SNFs with information about:

    §  The transition to the Patient Driven Payment Model (PDPM) which becomes effective on October 1, 2019.

    §  A review of SNF QRP changes and updates to the Minimum Data Set (MDS) 3.0 Version 1.17.0, which will become effective on October 1, 2019.

    §  An overview of the eleven SNF QRP Quality Measures.

    §  An interactive session on the use of reports to identify opportunities for process improvement and utilize information contained in reports available via the Certification And Survey Provider Enhanced Reports (CASPER) system to develop quality improvement plans.

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  • SNF Review and Correct Report Available (3/19)

    By QTSO - March 15, 2019

    SNF users were notified by CMS on Monday, March 11, that the Review and Correct report in the ‘SNF Quality Reporting Program ‘ category in the CASPER Reporting application would be unavailable while enhancements were being applied to the report. This report is now available and contains the following enhancements:

    • The addition of two new measures starting April 1, 2019:
     -Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury
     -Drug Regimen Review Conducted with Follow-up for Identified Issues – PAC SNF QRP
    • The removal of one measure starting with Q4 2018 results:
     -Percent of Residents or Patients with Pressure Ulcers That are New or Worsened (Short Stay) (NQF#0678)
    • The addition of Resident-Level data will now display with the Facility-Level data results.
     -A .csv file output will be available for the Patient-Level data
    • The Resident-Level and Facility-Level data will have new filter/sorting functionality within the CASPER Report Submit screen to customize the reporting results.

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  • CASPER Reporting User’s Guide for MDS Providers UPDATED (3/19)

    By QTSO - March 11, 2019
    Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.
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  • Tips for a Successful ACO Partnership!

    By Christina Gardiner - March 06, 2019

    Creating successful partnerships with Medicare accountable care organizations (ACOs) can seem like a daunting task for many skilled nursing facilities (SNFs), but with the right tools and strategic approaches, these relationships can be the cornerstone to clinical, and operational, success. Below are a few tips to assist in ACO success.

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  • FY 2021 SNF QRP Program Data Collection & Final Submission Deadlines - Revised (2/19)

    By CMS - February 21, 2019

    Skilled Nursing Facility Quality Reporting Program Data Collection & Final Submission Deadlines for the FY 2021 SNF QRP

    This table provides the data collection time frames and final submission deadlines for the Fiscal Year (FY) 2021 Skilled Nursing Facility Quality Reporting Program (SNF QRP). The first column displays the measure name, the second column displays the data collection time frame, and the third column displays the final data submission deadlines.


     

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    • SNF QRP 3Q 2018 Help Desk Q+A Doc Includes 2 GG Coding Q&As (2/19)

      By CMS - February 19, 2019
      A new Question and Answer (Q+A) document is now available from 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 third quarter (July - September) of 2018. It includes information about the SNF QRP program, as well as two section GG coding questions (related to GG0170N and GG0170O).
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    • Section GG’s Role in PDPM: The Basics

      By Caralyn Davis, Staff Writer - February 06, 2019
      MDS section GG (Functional Abilities and Goals) will replace section G (Functional Status) as a key payment driver for fee-for-service Medicare Part A residents paid under the Skilled Nursing Facility Prospective Payment System (SNF PPS) when the Patient-Driven Payment Model (PDPM) implements on Oct. 1, 2019. Using items from section GG instead of section G “advances CMS’s goal of using more standardized assessment items across payment settings,” said officials with the Centers for Medicare & Medicaid Services during the Dec. 11, 2018, SNF PPS: PDPM National Provider Call (NPC).
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    • The Long, Long List of Potential Medicare/Medicaid Claims Auditors

      By Caralyn Davis, Staff Writer - January 23, 2019

      Audit and medical review are terms that understandably put a lot of nursing homes on edge. The newsmakers in the Medicare/Medicaid billing arena are the U.S. Department of Justice (DOJ) and the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services (HHS), which lead some significant collaborative efforts.

       

      On the civil side, DOJ and the OIG regularly work with other agencies and law enforcement to coordinate False Claims Act (FCA) lawsuits, accruing more than $2.8 billion in FCA settlements and judgments just in fiscal year (FY) 2018 ending Sept. 30, 2018. It’s fairly common for nursing homes to be targeted in FCA lawsuits. For example, skilled nursing facilities (SNFs), their executives, and even their consultants paid more than $41 million to resolve FCA allegations in FY 2018, mostly related to rehabilitation therapy services that weren’t reasonable, necessary, and skilled, as well as for grossly substandard quality of care. In addition, there were several FY 2018 FCA cases tangentially involving nursing homes (e.g., a company facing FCA allegations related to paying nursing homes kickbacks).

       

      On the criminal side, the now 11 DOJ/OIG-led Medicare Strike Force teams based in high-fraud areas nationwide have charged more than 3,700 defendants who submitted over $14 billion in false Medicare billings since the program’s inception in 2007 under the interagency Health Care Fraud Prevention and Enforcement Action Team (HEAT). In June 2018, the Strike Forces led the nation’s largest-ever healthcare fraud enforcement action (aka Takedown Day), charging more than 600 doctors, nurses, and other licensed medical professionals in fraud cases worth more than $2 billion in false billings.

       

      The Strike Forces partner U.S. Attorney’s Offices, the FBI, and the OIG with other federal and local law enforcement agencies and state Medicaid Fraud Control Units. Using advanced data analysis techniques to find aberrant billing levels, suspicious billing patterns, and emerging schemes, the Strike Forces investigate and prosecute cases involving fraud, waste, and abuse in federal healthcare programs, including Medicare and Medicaid. Thus far, nursing homes haven’t been a significant target of the Strike Forces. In FY 2018, Strike Force teams brought only one case indirectly involving nursing homes.

       

      The Center for Program Integrity (CPI) runs point on healthcare fraud, waste, and abuse at the Centers for Medicare & Medicaid Services (CMS). These efforts start with a focus on improper billing and move all the way up to outright fraud and abuse, including working with the DOJ/OIG civil and criminal teams. Here are the key CMS contractors that could send nursing homes an additional documentation request (ADR) letter related to Medicare or Medicaid claims.

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    • Q&A: If a resident had a neck fracture with a hip replacement, would we code the aftercare for the joint replacement as the primary code?

      By Carol Maher, RN-BC, CPC, RAC-MT - January 23, 2019
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