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This section includes fact sheets on a variety of PDPM related topics.
PDPM Frequently Asked Questions
This section contains frequently asked questions (FAQs) related to PDPM policy and implementation.
PDPM Training Presentation
This section includes a training presentation which can be used to educate providers and other stakeholders on PDPM policy and implementation.
This section includes additional resources relevant to PDPM implementation, including various coding crosswalks and classification logic.
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.
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.
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.
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.
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.
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:
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)
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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