• MDS Items D0200 and D0300 Coding: Resident Mood Interview (PHQ-9) Video Tutorial (4/21)

    By CMS - April 02, 2021

    NEW TRAINING AVAILABLE – Resident Mood Interview (PHQ-9) for the Skilled Nursing Facility (SNF) Setting Video Tutorial

    CMS Resident Mood Interview (PHQ-9) for the SNF Setting Video Tutorial

    The Centers for Medicare & Medicaid Services (CMS) is releasing a video tutorial that depicts a scenario that demonstrates the interview of a resident and subsequent coding of D0200. Resident Mood Interview (PHQ-9©) and D0300. Total Severity Score. Various interviewing tips and techniques are highlighted in the video to promote accurate coding. The video tutorial is approximately 30 minutes in length and is designed to be used on demand anywhere you can access a browser.

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  • Postacute Sequelae of SARS-CoV-2 Infection (4/21)

    By ASPR TRACIE / HHS - April 01, 2021
    ASPR TRACIE (part of the US Department of Health and Human Services) received a request for information on clinical presentation, disease progression, and related information from clinicians in the field treating COVID-19 patients after the acute phase of the virus has passed, frequently referred to as “COVID long haulers.”
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  • QTSO Notice: MDS Long-Stay Residents in CASPER (4/21)

    By QIES Technical Support Office - April 01, 2021
    Attention QIES Users: CMS is in compliance with disposition authority N1-440-09-03 and only retains assessment and supporting data that is less than 10 years old in the QIES National database. Therefore, assessment-based quality measures generated in CASPER for reporting periods of 9 years* or older may be calculated with less than a full set of original assessment records. These reporting periods may not reflect the actual quality of care performed for episodes and stays within that time frame.

    *Note: Some assessment-based quality measures require a 2-year lookback period based on the target date of the stay or episode.

    CASPER reports currently impacted by the data retention policy:

    • MDS 3.0 Facility Level Quality Measure Report
    • MDS 3.0 Resident Level Quality Measure Report
    • MDS 3.0 Facility Characteristic Report
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  • SARS-CoV-2 Viral Mutations: Impact on COVID-19 Tests - New FDA Webpage (4/21)

    By FDA - April 01, 2021
    The FDA posted a new web page SARS-CoV-2 Viral Mutations: Impact on COVID-19 Tests for clinical laboratory staff and health care providers about the impact of viral mutations on COVID-19 molecular, antigen, and serology tests. This web page builds on the letter the FDA issued January 8, 2021, alerting clinical laboratory staff and health care providers to the potential for false negative results due to the impact of viral mutations on molecular SARS-CoV-2 tests. The web page includes specific molecular tests impacted by viral mutations and recommendations for those tests, including, new information on Cepheid Xpert Xpress SARS-CoV-2, Xpert Xpress SARS-CoV-2 DoD, and Xpert Omni SARS-CoV-2 tests. The FDA will update this page as significant new information about viral mutations and impact on COVID-19 tests becomes available. The FDA will announce any updates by email to CDRH In Vitro Diagnostics email list subscribers and in COVID-19 Update press releases.

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  • COVID-19 Vaccine Effectiveness Among Health Care Workers and Other Front-Line Workers (4/21)

    By CDC - March 31, 2021

    Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers — Eight U.S. Locations, December 2020–March 2021

     

    Weekly / April 2, 2021 / 70(13);495–500

    Summary

     

    What is already known about this topic?

    Messenger RNA (mRNA) COVID-19 vaccines have been shown to be effective in preventing symptomatic SARS-CoV-2 infection in randomized placebo-controlled Phase III trials.

    What is added by this report?

    Prospective cohorts of 3,950 health care personnel, first responders, and other essential and frontline workers completed weekly SARS-CoV-2 testing for 13 consecutive weeks. Under real-world conditions, mRNA vaccine effectiveness of full immunization (≥14 days after second dose) was 90% against SARS-CoV-2 infections regardless of symptom status; vaccine effectiveness of partial immunization (≥14 days after first dose but before second dose) was 80%.

    What are the implications for public health practice?

    Authorized mRNA COVID-19 vaccines are effective for preventing SARS-CoV-2 infection in real-world conditions. COVID-19 vaccination is recommended for all eligible persons.

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  • SNF QRP Webpage: How to Update Nursing Home/SNF Demographic Data (3/21)

    By CMS - March 26, 2021

    SNF Quality Reporting Program (QRP) quality data on Care Compare are updated on a quarterly basis.

    The Centers for Medicare & Medicaid Services (CMS) will be transitioning to a new data source for providers’ demographic data for all five Post-Acute Care (PAC) provider types (Skilled Nursing Facilities / Nursing Facilities (SNF/NFs), Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs) and Hospices).  These demographic data include such items as the provider name, provider-mailing address, provider physical address, State, ZIP Code, etc.  These provider demographic data are displayed on the Provider and Quality Measure reports generated from the Quality Improvement and Evaluation System (QIES) Certification and Survey Provider Enhanced Reports (CASPER) Reporting application for SNF/NF and Hospice providers and reports generated from Internet Quality Improvement and Evaluation System (iQIES) for HHA, IRF, and LTCH providers. Additionally these same demographic data are displayed on the public reporting websites such as the Provider Data Catalog (PDC).

    Historically provider demographic data have been maintained in the Automated Survey Processing Environment or ASPEN software; however, CMS will be transitioning to use the demographic information from Provider Enrollment, Chain and Ownership System (PECOS).  While this transition is underway, a final date when all demographic data will be obtained from PECOS has not been identified.  During this transition, all SNF/NF providers will be responsible to ensure their latest demographic data are updated and available in both the ASPEN and PECOS systems. 

    A referencing document that outlines the steps each PAC provider should follow can be accessed in the Downloads section of this webpage. Should you have questions regarding this updated process, please contact the iQIES help desk by email at iQIES@cms.hhs.gov or by phone at (800) 339-9313.

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  • CMS April 2021 Consolidated Billing Quarterly HCPCS Code File Update Will Span Four Years: 2021, 2020, 2019, 2017 - UPDATED (3/21)

    By CMS - March 25, 2021

    Transmittal # R10678CP

    Issue Date 2021-03-15

    Subject April 2021 Quarterly Update to HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement

    Implementation Date 2021-04-05

    CR # 12212

    Publication # 100-04

     I. GENERAL INFORMATION

    A. Background: The Centers for Medicare & Medicaid Services (CMS) periodically updates the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are excluded from the CB provision of the SNF Prospective Payment System (PPS). Services excluded from SNF PPS and CB may be paid to providers, other than SNFs, for beneficiaries, even when in a SNF stay. Services not appearing on the exclusion lists submitted on claims to Medicare Administrative Contractors (MACs), including Durable Medical Equipment MACs (DME MACs), will not be paid by Medicare to any providers other than a SNF. For non-therapy services, SNF CB applies only when the services are furnished to a SNF resident during a covered Part A stay; however, SNF CB applies to physical and occupational therapies and speech-language pathology services whenever they are furnished to a SNF resident, regardless of whether Part A covers the stay. In order to assure proper payment in all settings, Medicare systems must edit for services provided to SNF beneficiaries both included and excluded from SNF CB.

    This quarterly update will include revisions to the Part B SNF CB files for 2021, 2020, 2019, and 2017.

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  • CDC Infection Prevention and Control Assessment (ICAR) Tool for Nursing Homes Preparing for COVID-19 UPDATED (3/21)

    By CDC - March 19, 2021

    Guidance released March 10, 2021 regarding Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination | CDC affects only select elements of the current Nursing Home ICAR tool until an updated version of the tool is available. Please reference this guidance when using the ICAR tool to ensure alignment with updated considerations for COVID-19 vaccination status (e.g., visitation, HCP work restriction, resident quarantine).

    -----------------------------------------

    Infection Control Assessment and Response (ICAR) tools are used to systematically assess a healthcare facility’s infection prevention and control (IPC) practices and guide quality improvement activities (e.g., by addressing identified gaps).

    This tool is an update to the previous ICAR tool for nursing homes preparing for COVID-19. Notable changes as of November 20, 2020 include:

    • Additions to reflect updated guidance such as SARS-CoV-2 testing in nursing homes
    • Increased emphasis on the review of Personal Protective Equipment (PPE) use and handling
    • Addition of sections to help guide a video tour as part of a remote TeleICAR assessment or in-person tour of a nursing home
    • Addition of an accompanying facilitator guide to aide with the conduction of the ICAR and create subsequent recommendations for the facility

    This updated ICAR tool is a longer but more comprehensive assessment of infection control practices within nursing homes. Due to the addition of example recommendations to aid the facilitator during the process of conducting an ICAR, the facilitator guide version of the tool appears even longer. Facilitators may decide whether to use the tool in its entirety or select among the pool of questions that best fit their jurisdictional needs and priorities as part of quality improvement efforts.

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  • Potential Trend Alert: SNFs Sued re: Alleged False Five-Star Data for Nurse Staffing (3/21)

    By OIG - March 19, 2021

    Note from staff: This lawsuit, brought by the now director of the U.S. Department of Health and Human Services, not only alleges problems with the discharge process, it alleges that SNFs submitted false data to Five-Star, specifically nurse staffing data.

     

    Attorney General Becerra Sues Nursing Home Chain for Misrepresenting its Quality of Care and Putting Seniors, People with Disabilities at Risk

    Today's lawsuit pertains to Brookdale's current and former California skilled nursing facilities located in the cities of Bakersfield, Camarillo, Carlsbad, Northridge, Rancho Mirage, San Diego, San Dimas, San Juan Capistrano, Santa Rosa, and Yorba Linda 

    March 15, 2021

    SACRAMENTO – California Attorney General Xavier Becerra today joined a coalition of District and City Attorneys, led by Kern County District Attorney Cynthia Zimmer, in filing a lawsuit against Tennessee-based Brookdale Senior Living, Inc. (Brookdale), the nation’s largest senior living operator. Today’s lawsuit, which concerns Brookdale’s ten California skilled nursing facilities, alleges that Brookdale ignored laws that protect patients' safety when they are discharged from a facility. The lawsuit also alleges that Brookdale gave false information to the Centers for Medicare & Medicaid (CMS), information which CMS uses to award “star ratings” to skilled nursing facilities so that consumers can choose a quality facility. By lying to CMS, Brookdale fraudulently increased its star rating in several categories to attract prospective patients and their families.

    The lawsuit alleges that Brookdale failed to properly notify its patients and families of transfers and discharges. Skilled nursing facilities are required to give notice of transfer or discharge at least 30 days in advance, or as soon as practicable. Brookdale failed to timely provide this required notice to its patients, with a copy to the local ombudsmen. Brookdale also failed to properly prepare its patients for transfer or discharge. As a result of these actions, Brookdale endangered the health of its patients and also left families scrambling to find other places to care for their loved ones.

    The lawsuit also alleges that Brookdale misrepresented the quality of its care to the public by reporting false information to CMS. As a means of helping the public to choose a skilled nursing facility, CMS rates facilities on several quality measures on a scale of one to five stars, which are then posted to the CMS website. The lawsuit alleges that Brookdale over-reported its nursing staffing hours to CMS, and by doing so, Brookdale was awarded undeserved four-and five-star ratings. In the lawsuit, the coalition argues that by engaging in these unfair business practices, Brookdale violated both the Unfair Competition Law and False Advertising Law.

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  • The Big Dig and PDPM Gold

    By Jessie McGill, RN, RAC-MT, RAC-MTA - March 16, 2021

    The Patient-Driven Payment Model (PDPM) uses 161 MDS items to establish the five case-mix adjusted components. Some of these 161 items will have supporting documentation easily found in the medical record, but other items may require some digging. From burrowing through hospital records and querying the physician to probing staff for additional clarification, thoroughly mining the medical record can yield a substantial impact on both the accuracy of the assessment and PDPM billing codes.

    Read this article for tips on how to dig into the detailed information NACs need for calculating PDPM.

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  • MDS Item M1200: Think Past Checkmarks With Skin and Ulcer/Injury Treatments

    By Caralyn Davis, Staff Writer - March 15, 2021

    MDS item M1200 which reflects skin and ulcer/injury treatments in section M can impact payment under PDPM in the Medicare Part A skilled nursing facility prospective payment system, as well as affect reimbursement in some state Medicaid case-mix systems that use the RUG-III or RUG-IV case-mix models. However, it also plays a bigger role in both care planning and survey than many NACs and other interdisciplinary team members realize, points out Robin Hillier, CPA, STNA, LNHA, RAC-MT.

     

    Read this article to learn the keys to understanding this item’s impacts and to improving coding accuracy.

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  • March 30 CMS Webinar: SNF QRP: Achieving a Full APU: Register Now

    By CMS - March 15, 2021

    REGISTRATION OPEN – SNF QRP: Achieving a Full APU

    The Centers for Medicare & Medicaid Services (CMS) will host a webinar on Tuesday, March 30, 2021, from 1:00 p.m. to 2:30 p.m. ET to educate providers about the Annual Payment Update (APU) process to achieve full APU. This webinar will cover the relationship between the APU and the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP), associated data submission requirements, and the reconsideration process for providers who are identified as being noncompliant.

    Please register only if you know you will be able to attend the webinar, as space is limited. If you would like your name placed on a list to receive an email notification when the recorded version of the webinar is available, please CLICK HERE to be placed on an email notification list.

    CLICK HERE to register for the SNF QRP: Achieving a Full APU Webinar.

    If you have questions or need additional information regarding the logistics of this training session, please email the PAC Training mailbox at PACTraining@econometricainc.com.

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  • CMS QSO Memo: Five-Star Updates, Staff Counts, FAQs, and Access to Ombudsman Updated (3/21)

    By CMS - March 15, 2021

    Note: The Access to Ombudsman information is highlighted in red in the memo, but that is what was revised in July. The new updates focus on the updated Q&As under the section, Individuals Entering and Leaving Nursing Homes.

    Nursing Home Five Star Quality Rating System updates, Nursing Home Staff Counts, Frequently Asked Questions, and Access to Ombudsman (REVISED)

    Memo # QSO-20-28-NH REVISED 07/09/2020 UPDATED 03/10/2021

    Posting Date 2021-03-16

    Fiscal Year 2021 

    Memorandum Summary

    • CMS is committed to taking critical steps to ensure America’s nursing homes are prepared to respond to the threat of the COVID-19. 

    • Nursing Home Compare website & Nursing Home Five Star Quality Rating System: We are announcing that the inspection domain will be held constant temporarily due to the prioritization and suspension of certain surveys, to ensure the rating system reflects fair information for consumers.

    • Posting of surveys: CMS will post a list of the surveys conducted after the prioritization of certain surveys, and their findings, through a link on the Nursing Home Compare website.

    • Nursing Home Staff: CMS is publishing a list of the average number of nursing and total staff that work onsite in each nursing home, each day. This information can be used to help direct adequate personal protective equipment (PPE) and testing to nursing homes.

    • Access to Ombudsman: We are reminding facilities that providing ombudsman access to residents is required per 42 CFR § 483.10(f)(4)(i) and per the Coronavirus Aid, Relief, and Economic Security Act (CARES Act).

    • Frequently Asked Questions (FAQ): We are releasing a list of FAQs to clarify certain actions we have taken related to visitation, surveys, waivers, and other guidance.

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  • MedPAC Recommends No SNF PPS Payment Update for FY 2022 (3/21)

    By MedPAC - March 14, 2021
    The Medicare Payment Advisory Commission (MedPAC) releases its March 2021 Report to the Congress: Medicare Payment Policy. The report includes MedPAC’s analyses of payment adequacy in traditional fee-for-service (FFS) Medicare and reviews the status of Medicare Advantage (MA) and the prescription drug benefit (Part D).  As mandated by the Balanced Budget Act of 2018, the report includes an analysis of expanding Medicare’s inpatient hospital post-acute care transfer policy to hospice. Lastly, it reports on an option for Medicare's coverage of telehealth services after the coronavirus pandemic
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  • COVID-19 Medicare FAQs Updated (3/21)

    By CMS - March 13, 2021

    Documents include: 

    • Frequently Asked Questions to Assist Medicare Providers
    • Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction
    • Frequently Asked Questions (FAQs), CLIA Guidance During the COVID-19 Emergency
    • CLIA SARS-CoV-2 Variant FAQ

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