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.

  • 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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  • March 23 SNF/LTC Open Door Forum Agenda and Call-in Info UPDATED

    By CMS - March 20, 2017

    The next CMS Skilled Nursing Facilities (SNF)/Long Term Care (LTC) Open Door Forum scheduled for:  Date:  Thursday, March 23, 2017. Start Time:  2:00 PM – 3:00 PM Eastern Time (ET).

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  • Overview of New Psychotropic Drug Regulation (effective 11.28.17) and New Section N MDS Items (effective 10.1.17)

    By AADNS - March 08, 2017
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  • March 29 IMPACT Act Standardized Patient Assessment Data Activities Call: Register Now

    By CMS - March 08, 2017

    During this call, find out about efforts to develop, implement, and maintain standardized Post-Acute Care (PAC) patient assessment data, including pilot testing results and plans for the upcoming national field test. Topics:

    • Goal of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act)
    • Timeline of activities
    • Alpha 1 results
    • Alpha 2 progress
    • Plans for beta test
    • How to get involved
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  • Medicare Episode Payment Model Operations: CMS Transmittal (2/17)

    By CMS - February 24, 2017

    Rules for new Episode Payment Models (EPMs) that focus on acute myocardial infarction (AMI), coronary artery bypass graft (CABG), and surgical hip and femur fracture treatment (SHFFT), most frequently hip pinning. These models will begin in 2017 and run for 5 performance years (PY). Addresses the qualifying three-day hospital stay and other issues.

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  • SNF QRP QMs Adopted in FY 2016 SNF PPS Final Rule: Data Specs - Pressure Ulcer QM REVISED (2/17)

    By CMS - February 13, 2017

    The final Skilled Nursing Facility Quality Reporting Program specifications for the three MDS-based quality measures adopted through the FY 2016 final rule. Data collection on these three measures begins Oct. 1, 2016. NOTE: In February 2017 CMS revised the specifications for the pressure ulcer SNF QRP QM. Those specs are now found in a separate document.

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  • SNF QRP: TEP Summary Report for Refinement of Pressure Ulcer QM (2/17)

    By CMS - February 13, 2017
    The summary report for the refinement of percent of residents or patients with pressure ulcers that are new or worsened (Short-Stay) (NQF #0678) is now available. This report summarizes proceedings from a follow-up cross-setting pressure ulcer TEP meeting.
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  • Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents – New Payment Model (1/17)

    By CMS - January 09, 2017
     Learn about a new payment model for nursing facilities and practitioners to incent early identification of changes in condition, treatment of specific conditions in a nursing facility without a hospital transfer, and improved care planning. 
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  • Medicare Alternative Payment Models: Final Rule (12/16)

    By CMS - December 23, 2016

    HHS Finalizes New Medicare Alternative Payment Models to Reward Better Care at Lower Cost: Bundled payments for cardiac and orthopedic care, small-practice Accountable Care Organization opportunities to continue health care system’s shift toward value.


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  • SNF QRP: August 2016 Chicago Training Q&A Document

    By CMS - December 14, 2016
    Chicago SNF QRP Provider Training, August 2016, Question and Answer (Q&A) Document Now Available
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  • CMS Extends Fourth Quarter FY 2016 PBJ Submission Deadline to Dec. 1

    By Caralyn Davis, Staff Writer - November 22, 2016
    The Centers for Medicare & Medicaid Services (CMS) has decided to give nursing homes a little extra time to submit staffing data for the fourth quarter of fiscal year 2016 (July 1 – Sept. 30) to the Payroll-Based Journal (PBJ) electronic submission system, said officials during the Nov. 17 Skilled Nursing Facility/Long-term Care Open Door Forum (ODF). “Approximately 90 percent of providers have submitted PBJ data. [However], some providers experienced challenges,” they noted. “Also, the large number of provider submissions that occurred as we neared the submission deadline resulted in high network utilization, which subsequently caused slowed system response times for some users.”
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  • SNF QRP Extension / Exception due to Hurricane Matthew (11/16)

    By CMS - November 18, 2016

    The Centers for Medicare & Medicaid Services (CMS) is issuing a blanket exemption for data submission for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP), for Medicare providers adversely affected by the devastating impact of Hurricane Matthew. SNF providers located within the Federal Emergency Management Agency (FEMA)-designated “major disaster” counties in Georgia, Florida, North Carolina, and South Carolina will not be required to submit quality measure data to meet submission requirements for the reporting quarters specified by CMS.

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  • What’s Due November 28th: The Basics of Phase 1

    By Amy Stewart, RN, DNS-MT, RAC-MT, QCP-MT - November 10, 2016
    There are lots of changes on the horizon, with the three-phase implementation of the Final Rule (also known as the Mega-Rule) set to roll out over the next three years. A surprise to many is the recent news that CMS is not planning to update interpretive guidelines until 2017; CMS will update regulatory language for Phase 1 requirements under current F-Tags. Nonetheless, now is a good time to start looking closely at the new requirements in the Mega-Rule—especially those due with the implementation of Phase 1 on November 28, 2016. The good news is that Phase 1 implements requirements that, for the most part, already exist. Although relatively straightforward, these requirements still require changes that directors of nursing services (DNSs) need to be ready for. Here are the section-by-section changes that you don’t want to miss.
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  • INTERACT Implementation Tips: Boost Your Ability to Reduce Rehospitalizations

    By Caralyn Davis, Staff Writer - November 09, 2016

    Many directors of nursing services (DNSs) think of INTERACT (Interventions to Reduce Acute Care Transfers) as a toolkit with some communication forms designed to help reduce rehospitalization rates. “Really, it’s much more than that,” says Susan LaGrange, RN, BSN, NHA, CDONA, FACDONA, CIMT, director of education for Pathway Health in White Bear Lake, Minn. “INTERACT is a quality improvement (QI) program that helps providers identify early acute changes of condition so that they can manage them in-house when warranted. The program includes an implementation guide, quality improvement tools, communication tools, decision support tools, and advanced care planning tools.”

    LaGrange offers the following tips to help DNSs implement INTERACT for long-term success:

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  • New National Survey Process to Roll Out in November 2017

    By Caralyn Davis, Staff Writer - November 01, 2016
    Currently, states are split roughly 50-50 between the traditional survey process and the Quality Indicator Survey (QIS) process. However, the Centers for Medicare & Medicaid Services (CMS) will implement a new survey process nationwide—in addition to a brand-new F-tag coding system and some new interpretive guidance—during Phase 2 (effective Nov. 28, 2017) of the three-phase implementation schedule for the new regulations in the final rule to update the Medicare/Medicaid conditions of participation (CoPs), said agency officials during the Oct. 27 Long-Term Care Facilities: Reform of Requirements National Provider Call. 
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