• Dec. 12 SNF ODF Agenda and Call-in Information

    By CMS - December 11, 2019

    The next CMS Skilled Nursing Facilities (SNF)/Long Term Care (LTC) Open Door Forum scheduled for:  

    Date:  Thursday, December 12, 2019

    Start Time:  2:00 PM – 3:00 PM Eastern Time (ET);

    Please dial-in at least 15 minutes before call start time.

    Conference Leaders: Todd Smith & Jill Darling

    **This Agenda is Subject to Change**

    I.  Opening Remarks

    Chair – Todd Smith (Center for Medicare)

    Moderator – Jill Darling (Office of Communications)

    II.   Announcements & Updates

    *PDPM Update

    *Fiscal Year 2020 SNF VBP Facility-Level Dataset and SNF VBP Aggregate Performance

    III. Open Q&A

    **DATE IS SUBJECT TO CHANGE**

    Next ODF: TBD

    Mailbox: SNF_LTCODF-L@cms.hhs.gov

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  • Calendar 2020 Consolidated Billing HCPCS Code File: Exclusions and Inclusions (12/19)

    By CMS - December 11, 2019

    The SNF consolidated billing file reflects new codes that have been developed for 2020. In addition, the file reflects additions to categories of services excluded from consolidated billing.

    The annual update file below contains the complete list of HCPCS codes that are excluded from SNF CB for claims submitted to Part A MACs for payment. Minor Surgery and Part B therapy inclusions are also included with this file.

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  • SNF QRP QMs: NACs Should Review ‘The Report Card’ for PDPM

    By Caralyn Davis, Staff Writer - December 04, 2019

    The Patient-Driven Payment Model (PDPM) under the Skilled Nursing Facility Prospective Payment System (SNF PPS) pushes providers to implement value-driven care, which gives added significance to the Skilled Nursing Facility Quality Reporting Program (SNF QRP) quality measures (QMs), says Maureen McCarthy, BS, RN, RAC-MTA, RAC-MT, DNS-MT, QCP-MT, president/CEO of Celtic Consulting in Torrington, CT.

     

    “The SNF QRP QMs are now the report card for PDPM,” she explains. “The Centers for Medicare & Medicaid Services (CMS) has made it clear that the agency will be watching quality of care throughout PDPM implementation. If your care model changes and your quality goes down, you are likely to be audited. Nurse assessment coordinators (NACs) and any other interdisciplinary team (IDT) members who complete the MDS need to be mindful as to how that MDS data will impact not only payment but also quality, especially as more QMs continue to be added to the program.”

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  • NACs Need to Know: 5 Key Medicare Part A Requirements That Haven’t Changed Under PDPM

    By Caralyn Davis, Staff Writer - December 04, 2019

    The nurse assessment coordinator (NAC) often handles the entire Medicare program in the facility, from managing the PPS schedule to leading the skilled coverage decision. With PDPM in full swing, a lot seems to have changed, but some things have not.

     

    “The implementation of the Patient-Driven Payment Model (PDPM) changed the payment system used for traditional Part A residents,” says Suzy Harvey, RN-BC, RAC-CT, managing consultant at BKD in Springfield, MO. “It did not change the coverage policies for skilled services.”

    Key requirements that remain in place—and that NACs need to know about—include the following:

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  • Static OBRA Scheduling Tool

    By AANAC - December 04, 2019
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  • Interactive OBRA Scheduling Tool

    By AANAC - December 04, 2019
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  • jRAVEN 1.7.2 Free MDS Submission Software Updated (12/19)

    By CMS - December 04, 2019

    jRAVEN (version 1.7.2) is now available for download which contains the following updates:  

    • A defect has been corrected that was causing the HIPPS score that is calculated in jRAVEN to not match the score calculated by the Submission System
    • Changes in support of the MDS Data Specifications Errata V3.00.3
    • The new MDS VUT, version 3.2.0, also updated in support of the Errata V3.00.3
    • All enhancements included with jRAVEN V1.7.0 & V1.7.1:
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  • CASPER Reporting User’s Guide for MDS Providers UPDATED (12/19)

    By QTSO - December 04, 2019
    Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.
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  • MDS 3.0 Provider User's Guide Updated, Including Validation Rpt Error Messages (12/19)

    By QTSO - December 04, 2019
    Key information about how to submit MDS files and how to obtain and understand error messages on initial and final validation reports. 
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  • Appendix B State RAI Coordinators Contact List

    By CMS - December 04, 2019
    The November 28 update of Appendix B to the RAI Manual contains changes to the list of State RAI Coordinators, MDS Automation Coordinators, RAI Panel members, and Regional Office contacts.
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  • CMS Memo: Phase 3 Survey Guidance Will Be Released in Calendar 2Q 2020

    By CMS - November 27, 2019

    The Centers for Medicare & Medicaid Services (CMS) is announcing updates and initiatives aligning with the CMS strategic initiative to Ensure Safety and Quality in Nursing Homes. These updates and initiatives include:

     

    • Phase 3 Interpretive Guidance: CMS will be releasing updated Interpretive Guidance and training for the Requirements for Participation for Long-Term Care (LTC) Facilities. However, this guidance will not be released by the November 28, 2019 implementation date of the regulations. We will be releasing the guidance in the second quarter of calendar year 2020, along with information on training and implementing related changes to The Long Term Care Survey Process (LTCSP). While the regulations will be effective, our ability to survey for compliance with these requirements will be limited until the Interpretive Guidance is released.

    • Medicare and Medicaid Programs; Revision of Requirements for Long-Term Care Facilities: Arbitration Agreements: On July 18, 2019, the Department of Health and Human Services (HHS) published a final rule establishing requirements related to the use of binding arbitration agreements. This final rule amends the requirements that Long-Term Care (LTC) facilities must meet to participate with Medicare and Medicaid. 

    • Actions to Improve Infection Prevention and Control in LTC Facilities: CMS has created a nursing home antibiotic stewardship program training; updated the Nursing Home Infection Control Worksheet as a self-assessment tool for facilities; and is reminding facilities of available infection control resources.

    • Release of Toolkit 3, “Guide to Improving Nursing Home Employee Satisfaction”: CMS has created a toolkit that helps facilities improve employee satisfaction.

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  • Coding Section GG: A Case Study Review

    By Jessie McGill, RN, RAC-MT, RAC-MTA - November 25, 2019

    Collaboration. It is one of the key terms used to describe data collection for section GG, Functional Abilities and Goals. Collaboration among clinicians, to identify usual, and baseline conditions—these are also important terms used throughout section GG. But in a profession that is used to coding section G, Activities of Daily Living (ADLs), and calculating the Rule of 3, the process of determining usual performance for section GG holds some challenges. Does the data collected and documentation actually support how we are coding section GG? Let’s take a look at a case study of Mrs. Georgia Geoffrey and how the clinicians determined usual performance for some of the key GG tasks on her 5-Day assessment.

    Mrs. Georgia Geoffrey admitted to Happy Valley Nursing Facility following a knee replacement due to osteoarthritis. The wheelchair transport van wheeled her into the nursing home, and the nurse aide assigned to her alerted the nurse of her arrival and propelled her down the hall to her room. 

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  • Final Validation Reports: Best Practices for NACs

    By Caralyn Davis, Staff Writer - November 25, 2019

    A surprising number of nurse assessment coordinators (NACs) still don’t monitor the Final Validation Reports that the QIES ASAP MDS submission system automatically generates when each batch of MDS records is submitted, says Carol Maher, RN-BC, RAC-MTA, RAC-MT, CPC, director of education for Hansen, Hunter & Co. PC in Vancouver, WA.

     

    “When I go into facilities to work on a problem and ask MDS coordinators if they received any error messages or warnings on the Final Validation Reports for the MDSs in question, they often don’t know what I’m talking about,” notes Maher. “Some NACs have never even seen the Final Validation Reports because another staff member does the MDS transmissions on their computer.”

     

    These NACs are missing out on a critical step in the MDS submissions process, stresses Maher. “Reviewing every Final Validation Report allows the NAC to make sure that all of the MDSs were accepted into the federal database and to follow up on any fatal error or warning messages. While some software systems can show whether an MDS was accepted or rejected, they often don’t show warning messages—and each warning message is very important, giving you the information needed to determine if something should be modified or changed in that MDS.”

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  • LTCSP Survey Resources: Surveyor Tools (11/19)

    By CMS - November 25, 2019
    This ZIP file contains resources for surveyors conducting initial surveys under the Long-term Care Survey Process (LTCSP).
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  • LTCSP Procedure Guide - Updated (11/19)

    By CMS - November 25, 2019

    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).

     
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