• PDPM FAQs and Fact Sheets_Revised (2/19)

    By CMS - February 15, 2019

    Fact Sheets

    This section includes fact sheets on a variety of PDPM related topics.

    • Administrative Level of Care Presumption under the PDPM
    • PDPM Payments for SNF Patients with HIV/AIDS
    • Concurrent and Group Therapy Limit
    • PDPM Functional and Cognitive Scoring
    • Interrupted Stay Policy
    • MDS Changes
    • NTA Comorbidity Score
    • PDPM Patient Classification
    • Variable Per Diem Adjustment


    PDPM Frequently Asked Questions

    This section contains frequently asked questions (FAQs) related to PDPM policy and implementation.

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  • PDPM Training and Technical Resources, Including Grouper Logic & ICD-10 Crosswalks (2/19)

    By CMS - February 15, 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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  • CMS Transmittal and MLN Connects Article on PDPM Implementation (2/19)

    By CMS - February 14, 2019

    CR 11152 effectuates changes to the SNF Prospective Payment System (PPS) that are required for the PDPM. These changes were finalized in the FY 2019 SNF PPS Final Rule (83 FR 39162). SNFs billing on Type of Bill (TOB) 21X and hospital swing bed providers billing on TOB 18X, (subject to SNF PPS) will be subject to these requirements. Make sure your billing staff is aware of these changes.

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  • Ambulance Services and Consolidated Billing: OIG Report (2/19)

    By OIG - February 14, 2019

    Medicare Paid Twice for Ambulance Services Subject to Skilled Nursing Facility Consolidated Billing Requirements (A-01-17-00506)

    Prior OIG reviews identified significant Medicare Part B overpayments, including those to ambulance suppliers, for services they provided to Medicare beneficiaries during skilled nursing facility (SNF) stays covered under Medicare Part A. The Centers for Medicare & Medicaid Services (CMS) generally concurred with recommendations in these reports and implemented them. However, our analysis of recent claim data indicated that overpayments for ambulance transportation might still be occurring.

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  • Section GG’s Role in PDPM: The Basics

    By Caralyn Davis, Staff Writer - February 06, 2019
    MDS section GG (Functional Abilities and Goals) will replace section G (Functional Status) as a key payment driver for fee-for-service Medicare Part A residents paid under the Skilled Nursing Facility Prospective Payment System (SNF PPS) when the Patient-Driven Payment Model (PDPM) implements on Oct. 1, 2019. Using items from section GG instead of section G “advances CMS’s goal of using more standardized assessment items across payment settings,” said officials with the Centers for Medicare & Medicaid Services during the Dec. 11, 2018, SNF PPS: PDPM National Provider Call (NPC).
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  • Responding to ADRs Tool

    By AANAC - February 06, 2019
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  • How Tools Can Help Prepare You for Survey, Medicare Audits, and ADRs

    By Jane Belt, MS, RN, RAC-MT, RAC-CTA-MT, QCP - February 06, 2019

    The purpose of a tool in long-term care is largely is to make sure that the information that is  in each resident’s documentation is going to meet the requirements—whether regulation, guideline, or other. A tool is simply an easy way to go through a regulation (without having to read page after page), and apply it easily to the task at hand.  (For example, a Quality Assessment and Assurance audit divides the regulation into pieces calling out what the surveyor will look at to make sure the facility is in compliance. )

    Here are some of the most helpful tools available to you to prepare for survey, Medicare audits, and Additional Development Requests (ADRs), and best practices for how you should be using them.

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  • DRAFT MDS Data Specs and CAT Specs for Oct. 1, 2019

    By CMS - February 05, 2019

    A new version (V3.00.0) of the MDS 3.0 Data Specifications was posted.  This version is scheduled to become effective October 1, 2019.  Note that there are many significant changes, including the removal of eight item sets (NS, NSD, NO, NOD, SS, SSD, SO, SOD), the addition of two new item sets (IPA and OSA), and item additions in Sections A, GG, I, J, O and Z. These specs accommodate the utilization of the PDPM grouper, which also begins on October 1, 2019.

    In addition, a new version (V1.04.0) of the MDS 3.0 CAT Specifications was posted. This version is also scheduled to become effective October 1, 2019. The specification for CAT 12 (Nutritional Status) has been updated in accordance with the changes in V3.00.0 of the MDS 3.0 Data Specifications.

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  • Emergency Preparedness- Updates to Appendix Z of the State Operations Manual (1/19)

    By CMS - February 05, 2019

    CMS is updating Appendix Z of the SOM to reflect changes to add emerging infectious diseases to the definition of all-hazards approach, new Home Health Agency (HHA) citations, and clarifications under alternate source power and emergency standby systems.

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  • Q&A: A resident enters facility with a pressure ulcer at stage 4, which later becomes unstageable due to slough. If it later presents as a 3, how should I stage it?

    By Jane Belt, RN, MS, RAC-MT, RAC-CT, QCP - February 05, 2019
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  • Update: CASPER MDS 3.0 Quality Measure Reports Available (1/19)

    By QTSO - February 02, 2019

    MDS providers were notified by CMS on January 25th, that the reports in the 'MDS 3.0 Quality Measure Reports' category in the CASPER Reporting application would be unavailable while enhancements were being applied to the reports. These reports are now available and contain the following enhancements:


    • Calculation updates/changes to short stay pressure ulcer measure, long stay pressure ulcer measure, and the long stay weight loss measure
    • 'Hi-risk/Unstageable Pres Ulcer (L), N015.02' will display with 'Hi-risk Pres Ulcer (L), N015.01' measure results to see changes in calculations
    • A new legend is present to direct users to the SNF QRP Quality Measure CASPER reports to view results for the SNF QRP Pressure Ulcer (S) Measure
    • Updates made to columns/display for 508 compliance
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  • Review SNF QRP Provider Preview Reports Until March 4, 2019

    By CMS - February 01, 2019
    Skilled Nursing Facility Quality Reporting Program (SNF QRP) Provider Preview Reports have been updated and are now available. Providers have until March 4, 2019 to review their performance data prior to the April 2019 Nursing Home Compare site refresh, during which this data will be publicly displayed. Corrections to the underlying data will not be permitted during this time; however, providers can request CMS review of their data during the preview period if they believe the quality measure scores that are displayed within their Preview Reports are inaccurate. 
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  • SNF QRP Nursing Home Compare Updated W/ 1Q 2018 Data (1/19)

    By CMS - February 01, 2019

    The January 2019 Nursing Home Compare Refresh, including quality measure results based on SNF QRP data submitted to CMS, is now available.

    The updated SNF quality measure results are based on data submitted to CMS between:

    1.     Quarter 2 – 2017 to Quarter 1 – 2018 data

    o   Application of Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay) (#0674)

    o   Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short Stay) (NQF #0678)

    o   Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (#2631)

    2.     Quarter 4 – 2016 to Quarter 3 – 2017 data

    o   Medicare Spending Per Beneficiary – Post-Acute Care (PAC) Skilled Nursing Facility Measure

    o   Discharge to Community- Post Acute Care (PAC) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)

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  • CMS Section GG Decision Tree Training Document Available (1/19)

    By CMS - January 29, 2019

    A decision tree training document to help with coding Section GG self-care and mobility data elements is now available. This document provides an overview of the 6 codes and coding instructions for admission/discharge.

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  • CASPER Reporting User’s Guide for MDS Providers UPDATED (1/19)

    By QTSO - January 29, 2019
    Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.
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