• 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:

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  • 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.
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  • Scanning the Horizon: The Latest Updates to the RAI User’s Manual Effective October 1, 2018

    By Jane Belt, MS, RN, RAC-MT, QCP - August 28, 2018

    Just in time to help celebrate Labor Day, CMS has provided us with many pages to “labor” over in the few weeks that remain before October 1, 2018. Since August 22, we have had the opportunity to review the draft item sets and the technical specifications, but what our hearts most desired was to get the manual. And that we did—even a bit earlier than CMS had originally projected for its release. The good news: we have more time to absorb the changes that we have long been anticipating due to the SNF Quality Reporting Program. Let’s cover a high-level review of the chapter 3 updates and changes so that the horizon to October 1 will be clear.

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  • Q&A: If a resident appeals a notice for Medicare Part A coverage ending, should we complete the PPS Part A Discharge based on the last covered day or wait for a decision?

    By Carol Maher, RN-BC, CPC, RAC-MT - June 19, 2018
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  • Q&A: How is section GG coded if a Medicare Part A resident admits and discharges before day three of the stay?

    By Carol Maher, RN-BC, CPC, RAC-MT - May 14, 2018
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  • CMS Touts SNF Cost Savings Under the New PDPM Payment Model

    By Caralyn Davis, Staff Writer - May 04, 2018

    Skilled nursing facilities should save approximately $2 billion in aggregate reduced administrative costs over the next 10 years ($12,000 and 183 hours in savings per provider annually), said officials with the Centers for Medicare & Medicaid Services (CMS) in a review of key aspects of the Fiscal Year (FY) 2019 SNF PPS Proposed Rule during the May 1 Skilled Nursing Facility/Long-term Care Open Door Forum. This estimate is based on the proposed changes to the skilled nursing facility prospective payment system (SNF PPS) assessment schedule associated with the Patient-Driven Payment Model (PDPM) if it’s implemented as proposed on Oct. 1, 2019.

     

    “While the current [RUG-IV] system requires substantial paperwork to track the volume of service utilization over time, PDPM eliminates the need of these frequent patient assessments and allows clinicians to focus more time on treating the patient,” noted officials. Note: PDPM is based on the Resident Classification System, Version I, or RCS-I, that CMS presented last year.

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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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  • 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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  • Therapy and Nursing Collaboration on the Proposed Section GG Items

    By Mark McDavid, OTR, RAC-CT - April 04, 2018

    The anticipated October 1, 2018, changes to the MDS include a number of additions to section GG, according to technical specifications published in December by the Centers for Medicare & Medicaid Services (CMS). Additional data to be required in section GG will necessitate increased collaboration between nursing and therapy. As you may recall, section GG is a response to the IMPACT Act, and not collecting enough data may negatively impact your annual percentage update by as much as 2% of your reimbursement. Here is what you need to know.

     

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  • Q&A: Who should complete section GG and when? I am hearing conflicting advice.

    By Scott Heichel, RN, CIC, DNS-CT, RAC-MT - April 02, 2018
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  • Q&A: How do I interpret the percentages on the CASPER Review and Correct Report for SNF QRP measures?

    By Carol Maher, RN-BC, CPC, RAC-MT - April 02, 2018
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  • Section GG Overhaul Coming This Oct. 1 In Conjunction With New QMs

    By Caralyn Davis, Staff Writer - February 28, 2018
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  • Get Ready: Oct. 1, 2018, Will Bring MDS/RAI Changes

    By Caralyn Davis, Staff Writer - February 14, 2018

    The Centers for Medicare & Medicaid Services (CMS) has released two additional pieces of the puzzle to help nurse assessment coordinators (NACs) understand what MDS and other RAI changes will be implemented on Oct. 1, 2018. In November 2017, CMS posted the draft MDS item sets v1.16.0. Now the agency has released the draft MDS submission specs v2.02.0 and the MDS 3.0 care area trigger (CAT) specifications v1.03.0.

    The picture will remain somewhat fuzzy until CMS releases the corresponding update to the RAI Manual, which will include the all-important coding instructions. However, taken together, the available documentation offers critical information about what’s coming, including MDS item changes, CAT changes, and new error messages for MDS submissions to the QIES ASAP system.


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  • Section GG Web-based Training Module (1/18)

    By CMS - January 02, 2018
    The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training module to address questions submitted by providers during trainings between November 2015 and August 2016 related to Section GG across the Skilled Nursing Facility (SNF), Long-Term Care Hospital (LTCH), Inpatient Rehabilitation Facility (IRF), and Home Health (HH) care settings.  This training is designed to be used on demand anywhere you can access a browser and includes interactive exercises that allow you to test your knowledge in real life scenarios.
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  • It’s Not Just a Desk Job: Improving Person-Centered Care Through the RAI Process

    By Emily Royalty-Bachelor, Staff Writer - November 14, 2017

    There is no one right or wrong way to be a nurse assessment coordinator. The role often varies by state, by facility, and by the individual filling the role.

     

    But, suffice it to say, there are certain elements of the job that are applicable across the board—like, say, completing the MDS, or scheduling assessments.

     

    Tasks like these usually require the quiet solitude of an office with a closed door, or at least a computer to access software. So it’s understandable why many people might associate the role of a NAC with a desk job.

     

    But the truth is, the RAI process is not something that can be completed from your work chair. And if you’re spending the majority of your workday sitting at a desk, you’re missing out on key elements of your roles and responsibilities. The role of the NAC involves a lot of face-to-face interaction, both with the interdisciplinary team and—especially—with the residents.

     

    NACs, like every other member of the facility staff, are in the business of providing person-centered care. The operative word here is “person.” If you’re not interacting with the people, how can you ensure they’re at the center of the care you’re delivering?

     

    The RAI process, just like every component of care provided at the facility, needs to incorporate the resident’s voice and resident’s choice. Here’s how to make sure you’re doing just that:

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