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 Deadline Reminder: Calendar 2016 Submissions Due May 15

    By CMS - April 17, 2017
    The submission deadline for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) is approaching. Minimum Data Set (MDS) assessment data for October-December (Q4) of calendar year (CY) 2016 are due with this submission deadline. All data must be submitted no later than 11:59 p.m. Pacific Standard Time on May 15, 2017.
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  • SNF QRP Quick Reference Guide (4/17)

    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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  • May 2 SNF QRP Review and Correct Reports Provider Training: Register Now

    By CMS - April 06, 2017

    The Centers for Medicare & Medicaid Services (CMS) is hosting a live webcast for Skilled Nursing Facilities (SNFs) on Tuesday, May 2, 2017, from 2:00 to 3:30 p.m. ET.

    The focus of this training will be 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, the 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.

    You must register to attend.

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  • Nominate Patients / Experts for SNF QRP TEP by May 12

    By CMS - April 06, 2017

    Development and Maintenance of Quality Measures for Skilled Nursing Facility Quality Reporting Program (SNF QRP). The TEP nomination period opens on April 7, 2017 and closes on May 12, 2017. Please submit all nomination materials by the closing date.
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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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  • 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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  • 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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