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.

  • SNF QRP Review and Correct Reports Available (6/17)

    By QTSO - June 19, 2017

    The Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Review and Correct reports are now available on demand in the CMS Certification and Survey Provider Enhanced Reporting (CASPER) application. Providers can access these reports by selecting the CASPER Reporting link on the “Welcome to the CMS QIES Systems for Providers” webpage. NOTE: You must log into the CMS Network using your CMSNet user ID and password in order to access the “Welcome to the CMS QIES Systems for Providers” webpage.

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  • June 20 IMPACT Act Special Open Door Forum Call-in Info

    By CMS - June 12, 2017
    Centers for Medicare & Medicaid Services Special Open Door Forum: The IMPACT Act and Improving Care Coordination: This Special Open Door Forum (SODF) will provide information and solicit feedback pertaining to the Improving Medicare Post-Acute Care Transformation Act of 2014 (commonly referred to as the IMPACT Act). This SODF will focus on the goals of the IMPACT Act, update attendees on the RAND contract activities for item development, including the upcoming national testing, and identify opportunities for providers, consumers, stakeholders, researchers, and advocates to become involved over the next year.
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  • SNF QRP Technical Specs Table for Reporting MDS-Based QMs for FY 2017 (6/17)

    By CMS - June 05, 2017
    his table presents information to understand the reporting requirements for the assessment based quality measures that are included in the Centers for Medicare & Medicaid Services (CMS) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) for FY 2017. This table provides details for each MDS item and assessment type, allowable item values when coding for the 3 assessment based quality measures, Falls with Major Injury, Pressure Ulcers New or Worsened, and Functional Assessment and Care Plan.
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  • May 2 SNF QRP Review & Correct Reports Provider Training Q&As (5/17)

    By CMS - May 26, 2017

    May 2 Review and Correct Reports Provider Training Question and Answer (Q&A) Document for the Skilled Nursing Facility Quality Reporting Program Is Now Available: The question and answer (Q+A) document from the Review and Correct Reports Provider Training is now available in the “Downloads” section below. The Q+A document contains participant questions from the Live Webcast which took place on Tuesday, May 2, 2017.

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

    By CMS - May 26, 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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  • Final Notice: Meet June 1 SNF QRP Data Submission Deadline or Lose Part A $

    By Caralyn Davis, Staff Writer - May 24, 2017
    Skilled nursing facilities that participate in the skilled nursing facility prospective payment system (SNF PPS) have until 11:59 p.m. Pacific standard time on June 1, 2017, to correct and/or submit their MDS quality data for Oct. 1 – Dec. 31, 2016, to fulfill the requirements for the Skilled Nursing Facility Quality Reporting Program (SNF QRP) fiscal year (FY) 2018 payment determination. Some providers have been confused by the upcoming release of the SNF QRP Review and Correct Reports, thinking those reports would allow them to identify corrections they need to make to meet the 80 percent threshold. However, the Review and Correct reports relate specifically to the calculation of the SNF QRP quality measures (QMs), not to meeting the required data threshold for payment.
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  • SNF QRP Quality Measure (QM) User's Manual - NEW (5/17)

    By CMS - May 23, 2017

    This manual presents methods used to calculate quality measures that are included in the Centers for Medicare & Medicaid Services (CMS) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). This manual provides detailed information for each quality measure, including quality measure definitions, inclusion and exclusion criteria and measure calculation specifications.

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  • 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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  • 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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  • 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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