• 2019 Consolidated Billing Exclusions/Inclusions HCPCS Code File (12/18)

    By CMS - December 07, 2018

    The SNF consolidated billing file reflects new codes that have been developed for 2019. In addition, the file reflects additions to categories of services excluded from consolidated billing.

    The annual update file below contains the complete list of HCPCS codes that are excluded from SNF CB for claims submitted to Part A MACs for payment.  Minor Surgery and Part B therapy inclusions are also included with this file.  This file is effective for claims with dates of service on or after 1/1/2019 unless otherwise noted .

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  • CMS Addresses Medicaid RUG-III & RUG-IV Case Mix Effective Oct. 1, 2019

    By CMS - December 07, 2018

    Summary: States will have access to an optional assessment to support RUG-III and RUG-IV from October 1, 2019 through September 30, 2020. Effective, Oct. 1, 2020, states that continue to use RUG-III or RUG-IV after October 1, 2020 will need to implement a new process to gather the needed data because many of the corresponding MDS items will no longer be present on the MDS.


    On October 1, 2020 CMS will no longer support RUG-III and RUG-IV case-mix methodologies via the Minimum Data Set (MDS). PDPM utilizes a streamlined assessment schedule compared to RUG-III and RUG-IV by eliminating all current scheduled assessments, except the 5-day, and all unscheduled assessments (i.e., Other Medicare-Required Assessments). For States that rely on these assessments for calculating their case-mix group, CMS has created an optional assessment so that Medicaid payment is not adversely impacted when PDPM is implemented on October 1, 2019. States will have some flexibility in crafting policies associated with this assessment. The optional assessment will be effective from October 1, 2019 through September 30, 2020.

    Finally, in an effort to reduce provider burden, improve quality of care, and standardize data elements across provider settings, CMS will be removing several MDS data elements over the next few years. Many MDS data elements used in RUG-III and RUG-IV are no longer required for Federal purposes. With the removal of data elements, RUG-III and RUG-IV will no longer be functional. States that continue to use RUG-III or RUG-IV after October 1, 2020 will need to implement a new process to gather the needed data.

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  • Nursing Home Compare Claims-based Measures Technical Specifications Plus Appendix Updated (12/18)

    By CMS - December 07, 2018

    Nursing Home Compare Claims-based Measures Technical Specifications -Update December 2018  plus Appendix

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  • Part B Therapy: 2019 KX Modifier Thresholds (12/18)

    By CMS - December 06, 2018

    SUBJECT: Annual Update to the Per-Beneficiary Therapy Amounts

    I. SUMMARY OF CHANGES: The purpose of this Change Request (CR) is to describe the annual per beneficiary incurred expenses amounts now called the KX modifier thresholds and related policy for CY 2019. These amounts were previously associated with the financial limitation amounts that were more commonly referred to as “therapy caps” before the application of the therapy limits/caps was repealed when the Bipartisan Budget Act of 2018 was signed into law. Information related to this Recurring Update Notification can be found in Pub. 100-04, Chapter 5, Section 10.

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  • Some States Urge Providers to Check Freezers Due to National Ground Beef Recall (12/18)

    By USDA - December 06, 2018

    Some states, including Texas, have urged nursing homes to check their freezers for ground beef that may be recalled in this Class ! recall, meaning the beef should not be consumed.

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  • SNF/LTC ODF: CMS Talks Quality and Payment

    By Caralyn Davis, Staff Writer - December 04, 2018

    Change is the one constant nursing homes face these days as the Centers for Medicare & Medicaid Services (CMS) pushes providers to transform from an institutional, service-driven approach to a patient-focused, clinical-need approach that highlights quality of care and quality of life. While this drive began on the survey side with the implementation of the revised Medicare/Medicaid conditions of participation, it now also is taking root on the payment side via several quality programs impacting the fee-for-service Medicare Part A program.


    During the Nov. 29 Skilled Nursing Facility/Long-term Care Open Door Forum, CMS officials addressed programs on both sides of the aisle, including:

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  • SNF QRP’s Drug Regimen Review Items: Coding Tips

    By Caralyn Davis, Staff Writer - December 03, 2018

    Effective Oct. 1, 2018, skilled nursing facilities must capture three new drug regimen review items in section N (Medications) of the MDS for traditional fee-for-service Medicare Part A residents:


    ·         On every 5-day PPS MDS (A0310B = 01):

    o   N2001 (Drug Regimen Review), which asks, “Did a complete drug regimen review identify potential clinically significant medication issues?,” and

    o   N2003 (Medication Follow-up), which is completed if N2001 = 1 (yes) and asks, “Did the facility contact a physician (or physician-designee) by midnight of the next calendar day and complete prescribed/recommended actions in response to the identified potential clinically significant medication issues?”; and

    ·         On every Part A PPS Discharge assessment (A0310H = 1):

    o   N2005 (Medication Intervention), which asks, “Did the facility contact and complete physician (or physician-designee) prescribed/recommended actions by midnight of the next calendar day each time potential clinically significant medication issues were identified since the admission?”


    These three items play two key roles in the Skilled Nursing Facility Quality Reporting Program (SNF QRP):

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  • How to Resolve Stressful Situations and Strengthen Your IDT

    By Emily Royalty-Bachelor - December 03, 2018

    Building a positive atmosphere for teamwork can be challenging for the nurse assessment coordinator (NAC) in the best of times. Combining various personalities, managing multiple priorities, and juggling several deadlines all at once is no small task. Add into that the demanding environment of a long-term care facility and you’ve got a recipe for a stressed-out team, and possibly a broken workflow.


    You may be thinking there’s already enough to do during each day without having to worry about the quality of your teamwork. But the truth is that quality person-centered care starts with a strong interdisciplinary team (IDT). You all act as key players in meeting the needs of the residents. As such, you need to be able to depend on one another.


    Here are some tips on how the NAC can strengthen the IDT—even in stressful situations.

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  • ADL Holiday CNA Training Tool

    By AANAC - December 03, 2018
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  • SNF QRP Hurricane Michael Data Submission Exceptions (12/18)

    By CMS - December 03, 2018
    The memo lists specific counties that get the exceptions but also notes that SNFs outside those counties can request exceptions if there are extraordinary circumstances.
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  • CMS Alerts States re: SNFs/NFs With Potential Staffing Issues, Etc. (12/18)

    By CMS - December 02, 2018

    Payroll Based Journal (PBJ) Policy Manual Updates, Notification to States and New Minimum Data Set (MDS) Census Reports

    • Notification to States –

    The Centers for Medicare & Medicaid Services (CMS) will provide CMS Regional Offices (ROs) and State Survey Agencies with a list of facilities with potential staffing issues to support survey activities for evaluating sufficient staffing and improving resident health and safety.

    • Updates in the PBJ Policy Manual and Frequently Asked Questions (FAQs) – We are expanding the guidance on the meal breaks policy to ensure consistency. In addition, we are adding guidance regarding reporting hours for “Universal Care Workers.”

    • Additional Technical Support for Facilities – New MDS-based census reports in the Certification and Survey Provider Enhanced Reporting (CASPER) system.

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  • IMPACT Act National Beta Test on Standardized Data Assessment Elements: Early Findings (12/18)

    By CMS - November 30, 2018

    Early Findings from the RAND IMPACT National Beta Test of Candidate Standardized Patient Assessment Data Elements (SPADEs)


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  • PDPM FAQs and Fact Sheets (11/18)

    By CMS - November 26, 2018

    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 (11/18)

    By CMS - November 26, 2018

    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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  • CMPRP Nursing Home Staff Competency Assessment Toolkit (11/18)

    By CMS - November 26, 2018

    Toolkit 1: Nursing Home Staff Competency Assessment

    Quality care is complex. That’s why the CMPRP competency assessment helps nursing homes break down and self-examine some of the most important building blocks of quality care. Use the competency assessment to identify areas where your nursing home is doing well, versus where your facility might need support. Once you know where you need support, CMPRP can provide funding, technical assistance and learning opportunities to help address some of your facility’s toughest challenges, in order to offer the best possible care to your residents.

    There are three competency assessments in print and electronic formats:

    1) Certified Nursing Assistants (CNA)/Certified Medication Technicians (CMT)

    2)Licensed Practical/Vocational Nurses (LVN/LPN) and Registered Nurses (RN)

    3) Assistant directors of nursing (ADON), directors of nursing (DON) and administrators.

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