• Balancing Sections G and GG Requirements

    By Jessie McGill, RN, RAC-MT, RAC-MTA - July 10, 2019

    With the enormous focus on the transition from RUG-IV to PDPM, some may consider abandoning their section G Activities of Daily Living (ADLs) training materials, audits, and tools— but wait just a moment! Although section GG is stepping into the Medicare reimbursement spotlight, section G still plays a big role in other types of reimbursement and Quality Measures. To ensure success, the nurse assessment coordinator (NAC) must have a full understanding of the coding instructions, documentation requirements, impact on Quality Measures, and reimbursement for both section G and GG. Here are four key differences between the two sections and tips for successfully managing both.

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  • PDPM Lessons Learned From the Nursing RUGs

    By Caralyn Davis, Staff Writer - July 10, 2019

    On October 1 2019, the nursing case-mix groups used in the RUG-IV case-mix classification system will be streamlined and consolidated to form the nursing component of the Patient-Driven Payment Model (PDPM). By decreasing distinctions based on function for certain groups, the PDPM nursing component will use only 25 case-mix groups (ES3 – PA1) compared to the 43 RUG-IV nursing case-mix groups. For example, the RUG-IV groups HE2 and HD2 will be collapsed into the modified PDPM nursing case-mix group HDE2.

     

    However, the core process for assigning residents to a nursing case-mix group will remain basically the same, taking into account the use of extensive services, the presence of certain clinical conditions, the presence of depression, the provision of restorative nursing services, and the resident’s functional score (using section GG instead of section G). Consequently, nurse assessment coordinators (NACs) and other interdisciplinary team (IDT) members can learn some lessons about historically undercoded MDS items that could impact their ability to achieve the most accurate case-mix group for the PDPM nursing component, says Robin Hillier, CPA, STNA, LNHA, RAC-MT, president of RLH Consulting in Westerville, OH.

     

    Here are four items or sections worth revisiting:

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  • PDPM Training and Technical Resources, Including Grouper Logic & ICD-10 Mappings (7/19)

    By CMS - July 02, 2019

    PDPM Training Presentation

    This section includes a training presentation which can be used to educate providers and other stakeholders on PDPM policy and implementation.

    PDPM Resources

    This section includes additional resources relevant to PDPM implementation, including various coding crosswalks and classification logic.

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  • PBJ Provider User Guide V3.0.1, Incl. Error Messages / Descriptions - UPDATED (6/19)

    By QTSO - July 01, 2019
    This manual explains how to connect to the Payroll-Based Journal (PBJ) system and submit data. It also defines error messages and descriptions, identifying errors by number, severity, error message, and error description. The description section includes potential corrective actions for providers to take to resolve the errors.
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  • Section GG Web-based Training Module UPDATED (6/19)

    By CMS - June 27, 2019

    The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course on how to properly code of Section GG. This 45-minute course is intended for providers in the following care settings: Skilled Nursing Facilities (SNFs), Long-Term Care Hospitals (LTCHs), Inpatient Rehabilitation Facilities (IRFs), and Home Health Agencies (HHAs); and is designed to be used on demand anywhere you can access a browser. The course is divided into the following four lessons and includes interactive exercises that allow you to test your knowledge in real life scenarios:

    • Lesson 1: Importance of Section GG for Post-Acute Care

    • Lesson 2: Section GG Assessment and Coding Principles

    • Lesson 3: Coding GG0130.Self-Care Items

    • Lesson 4: Coding GG0170.Mobility Items

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  • CASPER Reporting User’s Guide for PBJ Providers UPDATED (6/19)

    By QTSO - June 21, 2019
    This user’s guide provides information and instructions pertaining to the CASPER Reporting application. Section 12, Payroll Based Journal (PBJ) Reports, addresses the staffing and census reports available to providers, including the Employee Report, the Census Report, the Staffing Summary Report, and the PBJ Submitter Final File Validation Report.
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  • CASPER Reporting User’s Guide for MDS Providers UPDATED (6/19)

    By QTSO - June 21, 2019
    Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.
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  • AAPACN CEO Attends NASEM Town Hall to Discuss Future of Nursing

    By AAPACN - June 18, 2019

    The National Academies of Sciences Engineering and Medicine (NASEM) hosted a Town Hall meeting in Chicago, IL on Friday, June 7 as part of the Future of Nursing: 2020-2030 project. The Future of Nursing project aims to “chart a path for the nursing profession to help our nation create a culture of health, reduce health disparities, and improve the health and wellbeing of the U.S. population in the 21st century.” Together with their Future of Nursing Campaign for Action and information about the latest in science and technology, they will put together a final report to assess “the capacity of the profession to meet the anticipated health and social care demands from 2020 to 2030.”

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  • Variable Per-Diem Adjustments Will Spotlight Skilling Decisions

    By Caralyn Davis, Staff Writer - June 18, 2019

    This October 1, the Patient-Driven Payment Model (PDPM) will introduce variable per-diem payment adjustments to providers paid under the Skilled Nursing Facility Prospective Payment System (SNF PPS). PDPM has five case-mix-adjusted components that each have an associated payment based on the case-mix group classification: physical therapy (PT), occupational therapy (OT), speech-language pathology services (SLP), nursing, and nontherapy ancillaries (NTA). For the PT, OT, and NTA components, case-mix group payments will decrease over the course of a Part A patient’s stay according to the predetermined schedules and adjustment factors found in Table 20, PT and OT Variable Per Diem Adjustment Factors, and Table 21, NTA Variable Per Diem Adjustment Factors, on page 6-48 of the draft version 1.17 Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual.

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  • Nursing Home Compare 2019 Anticipated Refreshes and Data Collection Timeframes for SNF QRP QMs (6/19)

    By CMS - June 16, 2019

    This table provides the data collection timeframes for quality measures in the Skilled Nursing Facility Quality Reporting Program (SNF QRP) displayed on the Nursing Home Compare website for Calendar Year (CY) 2019. The first column displays the plain language measure name used on the Compare website, the second column displays the full technical measure name, the third column displays the reporting cycle which describes the collection period and refresh frequency, and the last four columns contain the timeframe for each quarterly Compare website refresh.

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  • PACIO Project (Post-Acute Care Interoperability) Seeks Participants (6/19)

    By CMS - June 13, 2019
    The PACIO Project (Post-Acute Care Interoperability), pronounced "passeeo", launched on February 26, 2019. The goal of this collaborative partnership is to establish a framework for the development of a Fast Healthcare Interoperability Resource (FHIR) technical implementation guide(s) and Reference Implementations that will facilitate health information exchange through standards-based application programming interfaces (APIs). The objective of the PACIO Project is to use a consensus-based approach to advance interoperable health data exchange between post-acute care providers, patients, and other key stakeholders across the health care continuum with policy makers, standards organizations, and industry. This project is open to everyone, led by the MITRE Corporation, and participants include health IT vendors, providers, clinicians, researchers, standards organizations, CMS, ONC, and the VA.
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  • FY 2021 SNF QRP Table for Reporting Assessment-Based Measures (6/19)

    By CMS - June 11, 2019
    The SNF QRP Table for Reporting Assessment-Based Measures for the FY 2021 SNF QRP APU is now available for download on the Skilled Nursing Facility (SNF) Quality Reporting Program Measures and Technical Information webpage. This table indicates the MDS data elements that are used in determining the APU minimum submission threshold for the FY 2021 SNF QRP determination.
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  • CMS Section GG Training Videos: GG0110, GG0170C, GG0130B, Decision Tree for GG0130/GG0170 (6/19)

    By CMS - June 10, 2019

    These apply to all four QRP programs, including the SNF QRP:

    • GG0110 Prior Device Use with Information From Multiple Sources. This 4-minute video demonstrates how a caregiver can utilize information collected from multiple scenarios to accurately code GG0110. Prior Device Use. 
    • Decision Tree for Coding Section GG0130. Self-Care and GG0170. Mobility. This 12-minute video demonstrates how to apply the six-point coding scale to GG0130. Self-Care and GG0170. Mobility using GG0170D. Sit to stand as an example.
    • Coding GG0170C. Lying to sitting on side of bed This 4-minute video demonstrates how to distinguish between Code 02, Substantial/maximal assistance and Code 03, Partial/moderate assistance when coding GG0170C. Lying to sitting on side of bed.
    • Coding GG0130B. Oral HygieneThis 4-minute video demonstrates how to distinguish between Code 05, Set-up or clean-up assistance and Code 04, Supervision or touching assistance when coding GG0130B. Oral Hygiene. 
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  • At A Glance QM, QRP, and VBP Tool

    By AANAC - June 06, 2019
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  • SNF QRP Updates: What the NAC Needs to Know

    By Jane Belt, MS, RN, RAC-MT, RAC-MTA, QCP - June 06, 2019
    Keeping up with the changes occurring in long-term care is no easy task. Many of these developments significantly affect the role of the nurse assessment coordinator (NAC), which is evolving to encompass many different responsibilities. The NAC is central to numerous tasks of vital importance to a facility. For example, with the new Patient-Driven Payment Model (PDPM), the 5-Day PPS assessment can potentially set the payment for an entire skilled stay, unless an Interim Payment Assessment is opted for by the facility; managing residents with multiple and complex medical needs; alternative payments models, such as managed care, bundled payments, and health maintenance organizations; and recurring, prominent needs, like annual certification surveys, Five-Star ratings, and Nursing Home Compare quality measures, also require NAC attention. In this article, we will focus on one NAC function: the Skilled Nursing Facility Quality Reporting Program (SNF QRP). Although the SNF QRP represents only a small fraction of the NAC’s responsibilities, it demands significant time to complete associated tasks. Here, we’ll discuss which measures are being collected and reported in the SNF QRP and share suggestions to enable the busy NAC to stay on top of this responsibility.
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