• CMS Implements SNF Claims Hold (11/19)

    By CMS - November 06, 2019

    As CMS has undertaken the implementation of the Patient Driven Payment Model (PDPM), we are holding a limited number of Skilled Nursing Facility (SNF) claims while we make further refinements to our claims processing system.

     

    PDPM is a historic reform of the SNF prospective payment system. PDPM focuses on the patient’s condition and resulting care needs rather than on the amount of care provided in order to determine Medicare payment. PDPM was effective on October 1, 2019.

     

    Specifically, CMS is holding claims with:

    • Dates of service October 1, 2019 or later and
    • Type of Bill (TOB) inpatient services (21X) and swing bed services (18X) subject to SNF Patient Driven Payment Model (PDPM) and
    • Multiple line items, Health Insurance Prospective Payment System (HIPPS) codes, with different rate codes (revenue code 0022).

     

    Typically, SNFs bill these claims on monthly cycles. Claims with single HIPPS codes were previously being held but are now being released for processing. We anticipate releasing the remaining held claims in late November, once CMS completes systems testing to ensure accurate and timely payment. As of November 1, less than 50 claims are being held.

     

    In addition, we underpaid some SNF inpatient services (21X) and swing bed services (18X) claims for dates of service in October 2019 with a single line item, single HIPPS code. We are automatically reprocessing those claims; no provider action is needed.

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  • State RAI Coordinator Contact List Appendix B / RAI Manual Updated (10/19)

    By CMS - November 01, 2019
    The October 31 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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  • SNF QRP: CMS Extends Calendar 2Q 2019 Reporting Deadline to Nov. 18

    By CMS - November 01, 2019

    The submission deadline for the Skilled Nursing (SNF) Facility Quality Reporting Program (QRP) MDS assessment data submitted for April 1 – June 30 (Q2) of calendar year (CY) 2019 has been extended to November 18, 2019. All data must be submitted no later than 11:59 p.m. on November 18, 2019.

    As a reminder, it is recommended that providers run applicable CASPER/iQIES/NHSN analysis reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

    Swingtech sends informational messages to IRFs, LTCHs, and SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@swingtech.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

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  • Five-Star Technical User's Guide UPDATED AGAIN (10/19)

    By CMS - October 28, 2019

    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 twice in October 2019.


    October 2019 Revisions

    In October 2019, several changes were made to the Nursing Home Compare website and the Five-Star Quality Rating System. These changes affected the health inspection and quality measure domains. This section provides details on these changes.

    Ratings changes for facilities that receive the abuse icon: To make it easier for consumers to identify facilities with instances of non-compliance related to abuse, starting in October 2019, CMS added an icon to highlight facilities that meet either of the following criteria: 

    1. Harm-level abuse citation in the most recent survey cycle: Facilities cited for abuse where residents were found to be harmed (Scope/Severity of G or higher) on the most recent standard survey or on a complaint survey within the past 12 months. 
    2. Repeat abuse citations: Facilities cited for abuse where residents were found to be potentially harmed (Scope/Severity of D or higher) on the most recent standard survey or on a complaint survey within the past 12 months and on the previous (i.e., second most recent) standard survey or on a complaint survey in the prior 12 months (i.e., from 13 to 24 months ago). 

    Nursing homes that receive the abuse icon have their health inspection rating capped at a maximum of two stars. Due to the methodology used to calculate the overall rating, the best overall quality rating a facility that receives the abuse icon can have is four stars. 

    Removal of quality measures related to pain: CMS removed two quality measures (QMs) from the Nursing Home Compare website and the Five-Star Quality Rating System in October 2019. These measures are: 

    • Percentage of short-stay residents who report moderate to severe pain. 
    • Percentage of long-stay residents who report moderate to severe pain. 

    As a result of dropping these two measures, the cut-points for the long-stay, short-stay, and overall QM ratings changed. These changes were made to maintain, as close as possible, the same distribution of short-stay and long-stay QM ratings as were posted on Nursing Home Compare in July 2019. 

     

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  • SNF QRP October 2019 Nursing Home Compare Refresh (10/19)

    By CMS - October 28, 2019

    The October 2019 Nursing Home Compare Refresh, including quality measure results based on SNF QRP data submitted to CMS, is now available. For this refresh SNF QRP assessment-based measures performance scores will be based upon data submitted to CMS between Q1 2018 – Q4 2018 (1/01/18 – 12/31/18); claims-based measures performance scores will be based upon SNF Prospective Payment System (PPS) claims dated between Q4 2016 and Q3 2018 (10/01/16 – 9/30/18).

    CMS will no longer refresh the measure Percentage of Residents/Patients with Pressure Ulcers that are New or Worsened (NQF #0678), under the SNF QRP. The October refresh, as well as all subsequent refreshes of this quality measure data will be solely related to the CMS Nursing Home 5-Star Ratings.

    We are implementing the annual refresh of the SNF QRP claims-based measures during the October 2019 refresh of NH Compare. The annual refresh will include updates to the Medicare Spending per Beneficiary (MSPB) and Discharge to Community (DTC) measures. As previously announced, we have updated the methodology used to assign provider performance categories to the DTC measure. Additionally, this refresh includes the inaugural posting of provider performance scores for the Potentially Preventable Readmissions (PPR) measure, which were previously suppressed.

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  • CMS Dementia Care Resources Webpage (10/19)

    By CMS - October 25, 2019

    CMS has established a Dementia Care Resources page to provide information that was previously housed at the National Nursing Home Quality Improvement Campaign. Additional resources are available through the QIO program.


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  • CMS Section GG Training Videos: GG0130A, GG0110, GG0170C, GG0130B, Decision Tree for GG0130/GG0170 (10/19)

    By CMS - October 18, 2019

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

    • Coding GG0130A. Eating (6:19)The Centers for Medicare & Medicaid Services is releasing a short video tutorial to assist providers with coding GG0130A. Eating. This 6-minute video is designed to provided targeted guidance using simulated patient scenarios.
    • 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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  • Care Conferences: A Critical Step to Person-Centered Care

    By Emily Royalty-Bachelor - October 16, 2019

    Care conferences: maybe you’re familiar with them. Maybe you even attend them on a regular basis. But are you confident that your care conferences are meeting their intended purposes and making good use of everyone’s time? Here are some important details you need to know about hosting your care conferences as efficiently, yet thoroughly, as possible.

     

    What are care conferences?

    Care conferences (or care plan meetings) are gatherings of the interdisciplinary team (IDT) and the resident and/or their representative, during which they review a resident’s plan of care and adjust it as necessary. Care conferences are usually completed upon admission, and then once per quarter, following the MDS schedule.

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  • BMI Plays a Key Role From Reimbursement to Care Planning

    By Caralyn Davis, Staff Writer - October 16, 2019

    As a screening tool to identify potential weight problems for adults, body mass index (BMI) has always been important to document, but it gained new importance as a reimbursement factor for Medicare Part A residents under the Patient-Driven Payment Model (PDPM). Here’s what nurse assessment coordinators (NACs) need to know about BMI:

     

    Learn the NTA impact for PDPM

    “Residents who are morbidly obese may require a higher degree of nursing effort and skilled nursing care. Likewise, residents at the other end of the scale who are at risk for malnutrition also require more skilled nursing care,” says Pam Duchene, PhD, APRN-BC, NEA, FACHE, RAC-MT, DNS-CT, QCP, vice president of education and training for Harmony Healthcare International in Topsfield, MA.

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  • At A Glance QM, QRP, and VBP Tool

    By AANAC - October 15, 2019
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  • HHS Guide for Appropriate Tapering or Discontinuation of Long-Term Opioid Use (10/19)

    By US Department of Health and Human Services - October 15, 2019

    The U.S. Department of Health and Human Services published a new Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics - PDF. Individual patients, as well as the health of the public, benefit when opioids are prescribed only when the benefit of using opioids outweighs the risks.  But once a patient is on opioids for a prolonged duration, any abrupt change in the patient’s regimen may put the patient at risk of harm and should include a thorough, deliberative case review and discussion with the patient. The HHS Guide provides advice to clinicians who are contemplating or initiating a change in opioid dosage.

    “Care must be a patient-centered experience. We need to treat people with compassion, and emphasize personalized care tailored to the specific circumstances and unique needs of each patient,” said Adm. Brett P. Giroir, M.D., assistant secretary for health. “This Guide provides more resources for clinicians to best help patients achieve the dual goals of effective pain management and reduction in the risk for addiction.”

    Clinicians have a responsibility to coordinate patients’ pain treatment and opioid-related problems. In certain situations, a reduced opioid dosage may be indicated, in joint consultation with the care team and the patient. HHS does not recommend opioids be tapered rapidly or discontinued suddenly due to the significant risks of opioid withdrawal, unless there is a life-threatening issue confronting the individual patient.

    Compiled from published guidelines and practices endorsed in the peer-reviewed literature, the Guide covers important issues to consider when changing a patient’s chronic pain therapy. It lists issues to consider prior to making a change, which include shared decision-making with the patient; issues to consider when initiating the change; and issues to consider as a patient’s dosage is being tapered, including the need to treat symptoms of opioid withdrawal and provide behavioral health support. 

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  • SNF QRP: 2Q 2019 FAQs (10/19)

    By CMS - October 13, 2019
    A new Question and Answer (Q+A) document is now available in the "Downloads" section of the SNF Quality Reporting Program FAQs webpage. The Q+A document reflects frequently asked questions that were received by the SNF QRP Help Desk during the second quarter (Apr - Jun) of 2019.
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  • MDS 3.0 Quality Measures (QM) User's Manual V12.1 Re-posted (10/19)

    By CMS - October 09, 2019

    Nursing Home Quality Measure Changes

     The following nursing home quality measures have been removed:

    ·        Percentage of short-stay residents who report moderate to severe pain.

    ·        Percentage of long-stay residents who report moderate to severe pain.

    This change supports the federal initiative to reduce opioid utilization by seeking to prevent a potential scenario where the performance of a facility on the pain quality measures may inappropriately contribute to their decision to seek the administration of an opioid. 

    MDS 3.0 QM User’s Manual Version 12.1 Now Available

    The MDS 3.0 QM User’s Manual Version 12.1 has been posted. The MDS 3.0 QM User’s Manual V12.1 contains detailed specifications for the MDS 3.0 quality measures. The MDS 3.0 QM User’s Manual V12.1 can be found in the Downloads section of this page and the MDS 3.0 QM User’s Manual V12.0 has been moved to the Quality Measures Archive page.

    One file related to the MDS 3.0 QM User’s Manual has been posted:

    1.      MDS 3.0 QM User’s Manual V12.1 contains detailed specifications for the MDS 3.0 quality measures.

    2.      Quality Measure Identification Number by CMS Reporting Module Table V1.7 documents CMS quality measures calculated using MDS 3.0 data and reported in a CMS reporting module.  A unique CMS identification number is specified for each QM.

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  • CMS QSO Memos Explain New Five-Star Changes (10/19)

    By CMS - October 08, 2019

    Updates to the Nursing Home Compare website and the Five Star Quality Rating System

    Memo #QSO-20-02-NH

    Posting Date 2019-10-07

    Fiscal Year 2020

    Summary

    • CMS is removing the quality measures related to residents’ reported experience with pain from the Nursing Home Compare website and the Five Star Rating System.

    • We are also advising providers we will be updating the thresholds for quality measure ratings, according to the plan introduced in CMS Memorandum QSO-19-08-NH, in which the thresholds will be updated every six months. The first update will take place April 2020.

    • We are listing the dates the Nursing Home Compare website and the Five Star Rating System will be updated over the next few months.

     

    Consumer Alerts added to the Nursing Home Compare website and the Five Star Quality Rating System

    Memo #QSO-20-01-NH

    Posting Date 2019-10-07

    Fiscal Year 2020

    Summary

    • Abuse Indicator –CMS is updating the Nursing Home Compare website to make it easier for consumers to identify facilities with instances of non-compliance related to abuse.

    • Consumer Alert for Oregon Nursing Homes – CMS will be adding a consumer alert on the Nursing Home Compare website for all Oregon facilities indicating that incidents of abuse may not be reflected on the Nursing Home Compare website. This action is in response to a recommendation by the Government Accountability Office (GAO).

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  • CMS Updates Medicare Benefit Policy Manual, Claims Processing Manual for PDPM (10/19)

    By CMS - October 08, 2019

    CMS has revised SNF-focused chapters in the following manuals in the online manual system to account for the Patient-Driven Payment Model (PDPM):

    • Medicare Benefit Policy Manual;
    • Medicare Claims Processing Manual; and
    • Medicare General Information, Eligibility, and Entitlement Manual.



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