CMS held the first
skilled nursing facility (SNF) open door forum (ODF) call for this year on
February 14, 2019. The call included updates on CMS’ PDPM website, the SNF
Quality Reporting Program (QRP), and Payroll-Based Journaling (PBJ).
SNF QRP Update:
- CMS announced they are contracting with RTI
international to develop and maintain additional SNF QRP quality measures.
- RTI is convening a Technical Expert Panel
(TEP) to inform the direction and development of a claims-based measure of
healthcare-associated infections in SNF. For information on this project and
nomination steps visit the SNF QRP website.
- Fourth quarter (10/1/18-12/31/18) PBJ staffing
data will be considered timely if it was submitted by 2/14/19 and will be
posted on Nursing Home Compare.
CMS provided separate emails for questions
aspects and policy related issues.
In response to
questions on the ODF call, CMS indicated the goal for the publication of the
revised RAI manual is May, 2019 so providers have time to prepare for PDPM. The
current draft RAI manual can be downloaded here. MDS 3.0 Item Sets v1.17.0 (DRAFT) for October 1, 2019
Release [ZIP, 3MB]
Skilled Nursing Facility (SNF) 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.
To view the full memo and data contained within the report click here.
Clinical Appeals Corner
PEPPER is an educational tool that summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments. Providers can use the data to support internal auditing and monitoring activities. PEPPER provides resources for using the report, including user’s guides, recorded web-based training sessions and a sample PEPPER.
The PEPPER team has
recently updated the maps that display the PEPPER retrieval rates by state. See
how you compare and download yours today!
Visit PEPPER site.
Over the years, the burden associated with the current Medicare required assessment schedule has become “just part of the job.” Staffing of the MDS office is largely driven by Medicare part A census because all residents admitting to a facility for a skilled part A stay will receive a 5-day assessment and depending upon their length of stay may also have a 14-day, 30-day, 60-day, and 90-day assessment. Changes in therapy delivery trigger an additional set of required assessments.
CMS has boasted The Patient Driven Payment Model (PDPM) will reduce provider burden by implementing a significantly reduced required assessment schedule outlined as:5-day Scheduled PPS Assessment | Completed days 1-8 | Covers payment for ALL Part A daysPPS Discharge Assessment | Set as Medicare A stay end date. | Does not affect payment.
In addition to all OBRA requirements remaining the same, the Medicare required PPS assessment schedule consists of these two assessments. That’s it. CMS does acknowledge that changes in the resident’s clinical condition may affect resource use; therefore, they have created an optional Medicare assessment: Interim Payment Assessment (IPA) | Date facility chooses | Payment begins same day as ARD.(triggering event)
Read more about the importance of quality in our MDS assessments here.
CMS provides a Patient Driven Payment Model (PDPM) web page which houses a variety of resources (comorbidity mapping tools), fact sheets, and a training presentation. An additional resource is the 37 page PDPM Frequently Asked Questions document.
This document covers 14 PDPM topics and answers 92 questions as of 1/28/2019. On the December provider call, stakeholders requested revision dates be provided for reviewers to identify the most recent document update and CMS indicated this would be implemented.
As we progress toward PDPM’s implementation date, be sure to reference CMS’ website frequently to ensure up to date information and clarification.
Sharing patient success stories inspires clinicians and other patients alike. It’s vital to ensure the proper policy for sharing that information is followed.
We have provided you with a reference for these HIPAA requirements and Reliant’s Photo Release Form.
As we move into 2019, our focus is honed on the new payment model going into effect in October, PDPM. However, CMS continues to review current trends and initiate audits without a break in sight. With the continuation of Targeted Probe and Education (TPE) audits on the rise, strong supporting documentation, accurate billing practices and managing patient stays appropriately must be the focus of our treatment each and every day.
Read article here .
This week, Baltimore hosted CMS’ Quality Conference. McKnight’s Long Term Care News featured a recap of CMS administrator, Seema Verma’s “fiery speech” in which she indicated the Patient Driven Payment Model is the first step to move SNFs toward an “outcomes-based system.” She acknowledged continued focus on meaningful measures and offered insight into the future for CMS’s new app eMedicare and quality measure ratings.
Read full McKnight’s article .
A new DRAFT version of the 2019 MDS item sets (v1.17.0) , which is scheduled to take effect on October 1, 2019, was posted earlier this month to the MDS technical information webpage .
The files are located in the Downloads section at the bottom of the webpage (see MDS 3.0 Item Sets v1.17.0 (DRAFT) for October 1, 2019 Release [ZIP, 3MB] ).
This early draft is promising of more information to come. Reliant is monitoring CMS’ updates and postings for more information regarding October 2019 MDS and RAI changes.
CMS has finished mailing the new Medicare cards to beneficiaries across the United States.
CMS states Medicare fee-for-service health care providers submitted 58% of claims with new Medicare Beneficiary Identifiers (MBIs) indicating some success with integration. They encourage providers to utilize the new MBIs for all Medicare transactions even though the former Social Security Number-based health insurance claim numbers are permissible during the transition period.
Old cards may be used through December 2019. If a Medicare beneficiary states they have not yet received a new card, instructions are providedhere .