Billing and Payment Initiatives

Reforms in healthcare financing are changing the way care is reimbursed. Understand the ins and outs of everything from Medicare to Managed Care and stay on top of all of the changes that your facility needs to prepare for in the new era of billing and payment.

  • Advancing Care Coordination Through EPMs, Etc. Effective Date Change (5/17)

    By CMS - May 22, 2017

    Medicare Program: Advancing Care Coordination Through Episode Payment Models; Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model; Delay of Effective Date

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  • Feedback Reports / Public Reporting: SNF VBP Gears Up

    By Caralyn Davis, Staff Writer - May 16, 2017
    Effective Oct. 1, 2018, all skilled nursing facilities participating in the skilled nursing facility prospective payment system (SNF PPS) will be hit with a 2 percent reduction in their traditional fee-for-service Medicare Part A payments under the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program. Between 50 and 70 percent of the amount withheld will simultaneously be redistributed to high performers in the program as a value-based incentive payment. Providers will receive advance notice of their performance via quarterly confidential feedback reports.
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  • CMS Announcement: SNF QRP Data Submission Deadline Now June 1

    By CMS - May 12, 2017
    Due to extenuating circumstances, the reporting deadline for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Fiscal Year 2018 payment determination has been extended from May 15, 2017 to June 1, 2017.
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  • Consequences Grow for Missing PBJ Deadlines

    By Caralyn Davis, Staff Writer - May 08, 2017
    Beginning with the May 15, 2017, submission deadline for Payroll-Based Journal (PBJ), providers that have not submitted any staffing data for two consecutive deadlines (in this case February 14 and May 15) will have their overall and staffing star ratings suppressed—i.e., removed—from the Five Star Quality Rating System on Nursing Home Compare until data is received, said officials with the Centers for Medicare & Medicaid Services (CMS) during the May 4 Skilled Nursing Facility/Long-term Care Open Door Forum (ODF). In addition, Nursing Home Compare will continue to use an icon to indicate whether providers have submitted data by the most recent required deadline.
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  • Your Medicare $ is at risk: FY 2018 SNF PPS Proposed Rule

    By Carolyn Davis, Staff Writer - May 05, 2017
    Money will be extremely tight in fiscal year (FY) 2018—particularly for providers that haven’t met FY 2018 data submission requirements for the Skilled Nursing Facility Quality Reporting Program (SNF QRP), according to the FY 2018 SNF Prospective Payment System (PPS) Proposed Rule. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established a special rule for FY 2018 that requires a market basket percentage of 1.0 percent. That alone means that growth in aggregate SNF payments will slow dramatically in FY 2018 compared to FY 2017.

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  • SNF VBP: SNFRM Technical Report Supplement (5/17)

    By CMS - May 04, 2017
    April 2017 Skilled Nursing Facility Readmission Measure (SNFRM) NQF #2510: All-Cause Risk-Standardized Readmission Measure Technical Report Supplement – Skilled Nursing Facility Value-Based Purchasing program
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  • FY 2018 SNF PPS Proposed Rule: SNF QRP QM Data Specs and Standardized MDS items (5/17)

    By CMS - May 04, 2017

    Proposed MDS item set changes for v1.16 and proposed new Skilled Nursing Facility Quality Reporting Program (SNF QRP)  quality measures (QMs). If adopted data collection would begin Oct. 1, 2018.

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  • SNF QRP Review and Correct Reports Provider Training Slides (5/17)

    By CMS - May 04, 2017

    TRAINING MATERIALS AVAILABLE for the May 2 Review and Correct Reports Provider Training – Webcast. The focus of this training is to assist providers from the following care settings in better understanding how Review and Correct Reports fit within the overall Quality Reporting Program: Skilled Nursing Facilities, Inpatient Rehabilitation Facilities, and Long-Term Care Hospitals. Additionally, this training will provide information about re-submitting data to correct errors prior to the quarterly submission deadlines to ensure the accuracy of the data which will ultimately be publicly displayed.

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  • Bye-bye RUGs and OMRAs? Big changes in the works for SNF PPS

    By Caralyn Davis, Staff Writer - May 02, 2017
    The Centers for Medicare & Medicaid Services (CMS) has issued a precursor to a proposed rule that could lay the groundwork for retiring the existing case-mix classification model, the Resource Utilization Groups, Version 4 (RUG-IV), in the skilled nursing facility prospective payment system (SNF PPS). Switching to the Resident Classification System, Version I (RCS-I), would be a monumental change, ending the use of therapy minutes as the driver for Part A therapy payment, as well as accounting for variation in nursing and non-therapy ancillary (NTA) services.

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  • SNF Payment Models Research Technical Report (4/17)

    By CMS - April 27, 2017
    Based on the work conducted by Acumen during the second phase of the project, which included substantial feedback from stakeholders and four Technical Expert Panels, the contractor drafted a Technical Report, which discusses the research conducted by the contractor on developing an alternative to the existing methodology used to pay for services under the SNF PPS. The report identifies all of the relevant data and methodologies used in creating the contractor’s recommended alternative to the current case-mix classification system, RUG-IV, which they have named the Resident Classification System, Version I (RCS-I).
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  • FY 2018 SNF PPS Proposed Rule & Fact Sheet (4/17)

    By CMS - April 27, 2017
    Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2018, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, Survey Team Composition, and Proposal to Correct the Performance Period for the NHSN HCP Influenza Vaccination Immunization Reporting Measure in the ESRD QIP for PY 2020

     

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  • SNF QRP Quick Reference Guide - UPDATED (5/17)

    By CMS - April 17, 2017
    A Quick Reference Guide for the Skilled Nursing Facility Quality Reporting Program  (SNF QRP) is now available. This guide include frequently asked questions, information on QRP help desks, and helpful links to additional resources for the QRP.
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  • New SNF QRP FAQs Focus on MDS Section GG (4/17)

    By CMS - April 06, 2017
    SNF QRP Help Desk Q+A Document for the Fourth Quarter of 2016 Now Available
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  • MedPAC 2017 Report to Congress: Medicare Payment Policy (3/17)

    By MedPAC - March 26, 2017
    The Medicare Payment Advisory Commission (MedPAC) releases its March 2017 Report to the Congress: Medicare Payment Policy. The report includes MedPAC’s analyses of payment adequacy in fee-for-service Medicare and provides a review of Medicare Advantage and the prescription drug benefit, Part D.
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  • Nursing Facilities to be Nationally Ranked on Readmissions

    By Caralyn Davis, Staff Writer - March 21, 2017
    Effective Oct. 1, 2018, all skilled nursing facilities participating in the skilled nursing facility prospective payment system (SNF PPS) will be hit with a 2 percent reduction in their traditional fee-for-service Medicare Part A payments under the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program. 
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