• PDPM and ICD-10-CM Quick Reference Guide

    By AANAC - October 18, 2018
    Read more
  • Are You Using the Right FY 2019 Federal RUG Rates?

    By Caralyn Davis - October 16, 2018

    On Oct. 3, CMS published a correction notice for the Fiscal Year (FY) 2019 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule to address a series of technical errors. “Chief among those” were corrections to the total case-mix-adjusted federal per-diem RUG-IV payment rates that were necessary due to errors in copying values, said officials with the Centers for Medicare & Medicaid Services (CMS) at the Oct. 11 Skilled Nursing Facility/Long-term Care Open Door Forum (ODF).


    Specifically, CMS has issued updated versions of both Table 6, “RUG-IV Case-Mix Adjusted Federal Rates and Associated Indexes—Urban,” and Table 7, “RUG-IV Case-Mix Adjusted Federal Rates and Associated Indexes—Rural,” to correct the Total Rate column. For example, those tables in the FY 2019 SNF PPS final rule show federal RUX payment as $832.89 for urban SNFs and $852.10 for rural SNFs. The correction notice changes the federal RUX rate to $832.61 urban and $851.84 rural.


    Other FY 2019-specific corrections include the following:

    Read more
  • Q&A: Could you please clarify when and where deep tissue injuries (DTI) and other unstageable pressure ulcers will be included in Quality Measures?

    By Scott Heichel RN, DNS-CT, RAC-MT - October 16, 2018
    Read more
  • PDPM At-a-Glance Tool

    By AANAC - October 03, 2018
    Read more
  • CASPER Reporting User’s Guide for MDS Providers UPDATED (10/18)

    By QTSO - October 01, 2018
    Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.
    Read more
  • FY 2019 SNF PPS Final Rule PLUS Correction, Updated Wage Index Tables (10/18)

    By CMS - October 01, 2018
    Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities Final Rule for FY 2019, SNF Value-Based Purchasing Program, and SNF Quality Reporting Program

    This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2019. This final rule also replaces the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV) model, with a revised case-mix methodology called the Patient-Driven Payment Model (PDPM) beginning on October 1, 2019. The rule finalizes revisions to the regulation text that describes a beneficiary’s SNF “resident” status under the consolidated billing provision and the required content of the SNF level of care certification. The rule also finalizes updates to the SNF Quality Reporting Program (QRP) and the Skilled Nursing Facility ValueBased Purchasing (VBP) Program. 

    Correction Notice SUMMARY: This document corrects technical errors in the final rule that appeared in the August 8, 2018 Federal Register (83 FR 39162) entitled “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF) Final Rule for FY 2019, SNF Value-Based Purchasing Program, and SNF Quality Reporting Program.” DATES: The corrections in this document are effective October 1, 2018 .

    Read more
  • At A Glance QM, QRP, and VBP Tool

    By AANAC - September 25, 2018
    Read more
  • SNF QRP Measure Calculations and Reporting User's Manual Update (9/18)

    By CMS - September 14, 2018

    This manual presents methods used to calculate quality measures that are included in the Centers for Medicare & Medicaid Services (CMS) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). This manual provides detailed information for each quality measure (QM), including quality measure definitions, inclusion and exclusion criteria and measure calculation specifications.

    Read more
  • July 31/August 1 SNF QRP Post-Training Materials & Videos (9/18)

    By CMS - September 14, 2018


    Post-training materials (includes answers to knowledge checks) from the July/August 2018 Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Provider Training held in Baltimore, MD, on July 31 and August 1, 2018, are now available. Some screenshots included in presentations for the Section GG and Section N sessions and the Case Study Coding Sheet were updated to reflect recent changes to the Minimum Data Set (MDS) 3.0 Version 1.16.0, which will become effective October 1, 2018.
    Read more
  • SNF VBP Performance Score Report Overview video (8/18)

    By CMS - August 30, 2018
    Skilled Nursing Facility Value-Based Purchasing Performance Score Report Overview: 15-minute video from CMS
    Read more
  • SNF QRP FY 2020 Fact Sheet (7/18)

    By CMS - July 22, 2018
    The SNF QRP Reporting Requirements for FY2020 Reporting Year Fact Sheet is now available. This Fact Sheet contains information about requirements for the SNF QRP for the FY 2020 program year, which reflects data collected from 1/1/18–12/31/18. 
    Read more
  • AANAC Responds to FY 2019 SNF PPS Proposed Rule: Is Now the Time for PDPM?

    By Jessie McGill, RN, RAC-MT - July 10, 2018
    CMS took the long-term care profession by surprise in April when the SNF PPS Proposed Rule revealed the Patient-Driven Payment Model (PDPM). With a proposed implementation date of October 1, 2019, PDPM would replace RUG-IV without a phase-in or blended transition. CMS provided a 60-day comment period for the public to express concerns, support, and other feedback on the proposed rule, and AANAC responded. Following weeks of collaboration with our sister organization, AADNS, and with the Expert Advisory Panel members from both organizations, members, and other stakeholder groups, AANAC and AADNS jointly submitted 25 pages of comments to CMS. (For purposes of brevity in this article, the issuer of those comments is referred to as AANAC, but the collaborative effort should be understood.)
    Read more
  • CMS SNF VBP FAQs (7/18)

    By CMS - July 02, 2018

    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 readmissions 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?
    Read more
  • Proposed SNF Patient-Driven Payment Model (PDPM) for Medicare Part A: Technical Resources UPDATED (6/18)

    By CMS - June 20, 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). 

    June 2018 Update: A few typographical and usability issues were recently identified by certain stakeholders with SNF PDPM the classification logic (SNF PDPM Classification Walkthrough, Grouper Tool, and NTA Comorbidity Mapping).  In order to address these issues, CMS has posted revised versions of the three files below. Stakeholders should use these revised SNF PDPM files to inform their comments on the proposed rule.
    Read more
  • 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:


    Read more
1 of 8 Next