• CMS Addresses PDPM Claims Issue for Out-of-Sequence Claims, Will Correct in October (2/20)

    By CMS - February 26, 2020


    This message will appear in this week’s edition of MLN Connects, but we wanted to give our partners advance notice—please share with your members.

    SNF PDPM Claims Issue

    Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) initial claims that are processed out of sequence are not paying the correct Variable Per Diem (VPD)-adjusted rate. Also all adjustment claims are not processing correctly. Claims need to process in date of service order for each stay for the VPD to calculate correctly. We will correct this issue in October. In the interim:

    • Submit claims in sequence by waiting at least 2 weeks before billing subsequent claims
    • To adjust claims, cancel the initial claim and all subsequent claims in the SNF stay then rebill in sequential order; or, hold adjustments (when allowable) until October when they will process correctly
    • We encourage you to submit a complete bill at the time of entry


    Robin Fritter

    Director, Division of Provider Relations & Outreach

    Provider Communications Group
    Centers for Medicare & Medicaid Services

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  • CASPER Reporting User’s Guide for MDS Providers UPDATED (2/20)

    By QTSO - February 26, 2020
    Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.
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  • At A Glance QM, QRP, and VBP Tool

    By AANAC - February 24, 2020
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  • Five-Star Helpline Open 2/24 - 2/28

    By CMS - February 21, 2020

    The Five Star Preview Reports are available as of February 18, 2020. 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 February's Five Star data on February 26, 2020.

    Important Note: The 5 Star Help line (800-839-9290) will be available February 24, through February 28, 2020.

    Please direct your inquiries to BetterCare@cms.hhs.gov  if the Help Line is not available

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  • Appendix Z, Emergency Preparedness, State Operations Manual Update (2/20)

    By CMS - February 21, 2020

    SUBJECT: Revisions to the State Operations Manual (SOM) Appendix A - Hospitals, Appendix AA – Psychiatric Hospitals, Appendix B – Home Health Agency, Appendix D - Portable X-Ray, Appendix G - Rural Health Clinics/Federally Qualified Health Centers, Appendix H- End Stage Renal Disease Facilities (ESRD), Appendix K – Comprehensive Outpatient Rehabilitation Facility, Appendix L - Ambulatory Surgical Centers, Appendix M – Hospice, Appendix U - Religious Nonmedical Healthcare Institutions, Appendix W - Critical Access Hospitals (CAHs), Appendix X - Organ Transplant Program and Appendix Z - Emergency Preparedness




    This Transmittal includes regulatory revisions based on recent federal regulation changes (CMS-3346-F; CMS-3334-F; CMS-3295-F; CMS3277-CN). In addition, several updates to the appendices have been made for technical correction and clarity. The psychiatric hospital tags have moved from Appendix AA to Appendix A. Appendix AA is being deleted as surveyors will now refer to Appendix A for the psychiatric special condition tags and guidance. Specific references to the United States Pharmacopeia (USP) have been removed from Appendices A, G, and W accordingly, as CMS requires compliance with applicable Federal and State law and adherence to accepted general standards of practice or guidelines for pharmaceutical services and medication administration issued by nationally recognized professional organizations. Appendix H updates the regulatory text based on requirements set forth in the 2008 Conditions for Coverage for ESRD Facilities and also includes revisions based on recent Federal regulation changes set forth in “Fire Safety Requirements for Certain Dialysis Facilities (CMS-3334-P).” Revisions to Appendix W also include renumbering the C-Tags; inserting regulations §485.601, §485.603, §485.604, and §485.606; and inserting the CAH Distinct Part Unit and Emergency Medical Treatment and Labor Act (EMTALA) C-Tags for reference. This transmittal will assure each of the appendices are updated to reflect the current regulatory language within the Medicare conditions. More substantive interpretive guidance revisions in several sections are pending and will be updated with a future release. 

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  • CASPER Reporting User’s Guide for PBJ Providers UPDATED (2/20)

    By QTSO - February 20, 2020
    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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  • How to Begin Prepping for October 1 MDS Changes

    By Caralyn Davis, Staff Writer - February 19, 2020

    With the implementation of the Patient-Driven Payment Model (PDPM) now fully under way for the Skilled Nursing Facility Prospective Payment System (SNF PPS), the Centers for Medicare & Medicaid Services (CMS) has begun turning the attention of nurse assessment coordinators (NACs) toward a new slate of changes that will implement this October 1, 2020. In December, CMS posted the draft version 1.18.0 MDS item sets, and in January, the agency followed up with the release of the 43-page MDS 3.0 Item Set Change History for October 2020 Version 1.18.0, which lays out—item by item—what new or revised items will be added to which item sets, as well as what items will be deleted from which item sets.


    Changes will occur in the following MDS sections:

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  • 3 Simple Ways Nurse Assessment Coordinators (NACs) Can Help Support Staff Retention

    By Jessica Kunkler, MA, Staff Writer - February 19, 2020

    Staff turnover is everyone’s problem, and in facilities across the United States, it’s a big one. One in four  nursing assistants and one in five home health aides report that they are actively looking for another job, according to the Recruitment and Retention Guide For Employers by PHI.

    Not only is turnover expensive, it negatively impacts residents. High turnover can result in less personalized care, an increased risk of infectious diseases among residents, and lowered quality of life and care.

    It also makes everyone’s job harder. As every NAC knows, a rotating door of floor nurses, CNAs, and other NACs means constant trainings on the same processes and repetitive reminders about how things are done correctly as newbies get up to speed.  

    Here are three ways that the NAC can support staff retention and make everyone’s time in their long-term care facility better.

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  • CMS Tool

    By AANAC - February 19, 2020
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  • FY 2022 SNF QRP Quick Reference Guide (2/20)

    By CMS - February 18, 2020
    Quick Reference Guide for FY 2022 is now available. The Quick Reference Guides provide high-level information on the SNF Quality Reporting Program, including frequently asked questions and helpful links.
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  • FY 2021 SNF QRP Quick Reference Guide (2/20)

    By CMS - February 18, 2020

    Quick Reference Guide for FY 2021 is now available. The Quick Reference Guides provide high-level information on the SNF Quality Reporting Program, including frequently asked questions and helpful links.

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  • CMS Proposes PASRR Changes (2/20)

    By CMS - February 18, 2020

    DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 431, 433, 435, 441, and 483 [CMS-2418-P] RIN 0938-AT95 Medicaid Program; Preadmission Screening and Resident Review

    AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

    ACTION: Proposed rule.

    SUMMARY: This proposed rule would modernize the requirements for Preadmission Screening and Resident Review (PASRR), currently referred to in regulation as Preadmission Screening and Annual Resident Review, by incorporating statutory changes, reflecting updates to diagnostic criteria for mental illness and intellectual disability, reducing duplicative requirements and other administrative burdens on State PASRR programs, and making the process more streamlined and person-centered.

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  • CMS QSO Memo Explains 2 New Toolkits to Ensure Safety and Quality in Nursing Homes (2/20)

    By CMS - February 18, 2020

    CMS developed optional toolkits to aid nursing home teams with reducing adverse events and improving dementia care. These toolkits were the result of CMS work with nursing home Breakthrough Communities—a learning collaborative design where a subset of nursing homes joined learning sessions and team calls to learn about quality improvement concepts.

    Memorandum Summary

    The Centers for Medicare & Medicaid Services (CMS) is announcing the release of two toolkits that align with the CMS strategic initiative to Ensure Safety and Quality in Nursing Homes.

    • Developing a Restful Environment Action Manual (DREAM) Toolkit – CMS has created a toolkit that offers education and person-centered, practical interventions that nursing home administrators, directors of nursing, and bedside staff can implement to promote high-quality sleep for residents living with dementia.

    • Head-to-Toe Infection Prevention (H2T) Toolkit – CMS has created a toolkit that offers educational materials and practical interventions for bedside staff designed to prevent common infections by improving activities of daily living (ADL) care.

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  • CMS QSO Memo re: Coronavirus and Healthcare Facility Expectations (2/20)

    By CMS - February 10, 2020

    Memo #20-09-ALL

    Posting Date 2020-02-06

    Fiscal Year 2020


    • Information Regarding Patients with Possible Coronavirus Illness: the U.S. Centers for Disease Control and Prevention (CDC) has issued information on the respiratory illness caused by the 2019 Novel Coronavirus (2019-nCoV). Links to these documents are provided.
    • Healthcare Facility Expectations: CMS strongly urges the review of CDC’s guidance and encourages facilities to review their own infection prevention and control policies and practices to prevent the spread of infection.
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  • Do You Know Who Your New QIN-QIO Is? (2/20)

    By Staff - February 05, 2020

    In November 2019, the Centers for Medicare & Medicaid Services quietly implemented the 12th Statement of Work for the Quality Improvement Network Quality Improvement Organizations (QIN-QIOs).

    This five-year contract includes a shift in how/where the QIN-QIOs operate. There are now 14 Medicare-funded QIN-QIOs nationwide. For example, IPRO is a lead contractor partnering with two other QIOs to cover 11 states and the District of Columbia. IPRO will direct activities in New York, New Jersey, and Ohio; Healthcentric Advisors will cover all six New England states (Maine, New Hampshire, Vermont, Massachusetts, Connecticut, and Rhode Island); and Qlarant will handle Maryland, Delaware, and the District of Columbia.

    "QIN-QIOs serving under the 12th Statement of Work will provide customized quality improvement to nursing homes and providers, serving rural communities and the most vulnerable populations. Through this body of work, CMS is focusing on results, protecting taxpayer dollars, and most importantly, ensuring the safety and quality of care delivered to every Medicare beneficiary," says HealthCentric Advisors.

     The QIN-QIOs will address nursing home and community coalition quality improvement in the following areas:

    • Improving Behavioral Health Outcomes – Including Opioid Misuse
    • Increasing Patient Safety
    • Increasing Chronic Disease Self-Management
    • Increasing the Quality of Care Transitions
    • Improving Nursing Home Quality
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