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CMS created the Five-Star (5 Star) Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Five-Star Quality Rating System Technical Users' Guide provides in-depth descriptions of the ratings and the methods used to calculate them. Updated April 2018.
The Five Star Preview Reports will be available on April 23. To access these reports, select the CASPER Reporting link located on the CMS QIES Systems for Providers page. Once in the CASPER Reporting system, select the 'Folders' button and access the Five Star Report in your 'st LTC facid' folder, where st is the 2-character postal code of the state in which your facility is located and facid is the state-assigned Facility ID of your facility.
Nursing Home Compare will update with April's Five Star data on April 25, 2018.
Important Note: The 5 Star Help line (800-839-9290) will be available April 23, 2018 through April 27, 2018. Please direct your inquiries to BetterCare@cms.hhs.gov if the Help Line is not available.
The LTCSP Procedure Guide provides instruction on the procedural and software steps necessary for completing the Long-term Care Survey Process. Surveyors use the Procedure Guide for all standard surveys of SNFs and NFs, whether freestanding, distinct parts, or dually participating. The LTCSP steps are organized into seven parts: 1) offsite preparation; 2) facility entrance; 3) initial pool process; 4) sample selection; 5) investigation; 6) ongoing and other survey activities; and 7) potential citations. Below is a broad overview of the key onsite parts of the LTCSP (parts 3 – 7).
CMS has extended the Skilled Nursing Facility Quality Reporting Program (SNF QRP) deadlines for calendar year (CY) 2017. Minimum Data Set (MDS) assessment data for January-December (Q1-Q4) of CY 2017 are due May 15, 2018. However, providers are encouraged to verify their MDS submissions on at least a quarterly basis.
It is recommended that the applicable CMS CASPER validation reports are run prior to each quarterly reporting deadline to ensure that all required data were submitted. We encourage you to verify all facility information prior to submission, including CCN and facility name.
The Edit Change Report posted in the DRAFT version (v2.02.0) of the MDS 3.0 Data Specifications is missing the second page of the report. A replacement PDF of the report containing the missing page was posted.
An errata (V2.02.1) was posted for the DRAFT version (v2.02.0) of the MDS 3.0 Data Specifications, which are scheduled to go into effect on October 1, 2018. Ten issues have been identified; five are revisions to edits and five are new edits.
The revised Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN; Form CMS-10055) is about to become the mandatory financial liability notice for traditional fee-for-service Medicare Part A skilled care. To ensure smooth implementation and improve how their facility manages the process, nurse assessment coordinators (NACs) who do dual-duty as the Medicare nurse should take the following steps:
• Transition to Payroll-Based Journal (PBJ) Data – Starting in April, 2018, CMS will use PBJ data to determine each facility’s staffing measure on the Nursing Home Compare tool on Medicare.gov website, and calculate the staffing rating used in the Nursing Home Five Star Quality Rating System.
• Staffing data audits - We are providing lessons-learned from audits conducted, and guidance to facilities for improving their accuracy. Nursing homes whose audit identifies significant inaccuracies between the hours reported and the hours verified, or facilities who fail to submit any data by the required deadline will be presumed to have low levels of staff. This will result in a one-star rating in the staffing domain, which will drop their overall (composite) star rating by one star for a quarter.
• Requirement for registered nurse (RN) staffing – We are reminding nursing homes of the importance of RN staffing and the requirement to have an RN onsite 8 hours a day, 7 days a week. Nursing homes reporting 7 or more days in a quarter with no RN hours will receive a one-star rating in the staffing domain, which will drop their overall (composite) star rating by one star for a quarter. This action will be implemented in July 2018, after the May 15, 2018 submission deadline for data for 2018 Calendar Quarter 1, 2018 (January – March, 2018) data.
Quality Improvement Team Development is one part of the Performance Management Series. The work of a QI project is accomplished by a team of individuals, which is known as a QI Team. The purpose of the team is to design, manage, and monitor performance improvement activities to achieve the aim of the QI Project.
At the end of this tutorial you will be able to:
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.
Effective Oct. 1, 2017, the Centers for Medicare & Medicaid Services (CMS) implemented the Targeted Probe and Educate (TPE) program for medical record reviews across all Medicare administrative contractors (MACs) in order to identify common errors in claims and help providers improve claim accuracy in those very specific areas. Note: CMS-directed prior-authorization and automated reviews fall outside of the TPE program.
Using data analysis, MACs identify providers with high claim error rates or unusual billing practices, as well as items and services that pose a financial risk to Medicare due to their high national error rates. Providers that don’t have high claim error rates or unusual billing practices won’t participate in TPE. For those that do, here are the basics of how it works, according to CMS’ TPE handout and Transmittal 2035:
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