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.

  • At A Glance QM, QRP, and VBP Tool

    By AADNS - April 18, 2019
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    By CMS - April 05, 2019

    Topics covered include:

      • What is the Skilled Nursing Facility Value-Based Purchasing Program?
      • What SNFs are included in the SNF VBP Program?
      • What measure is currently being used in the SNF VBP Program?
      • What is the difference between a planned readmission and an unplanned readmission?
      • When does the SNFRM 30-day period begin and end?
      • Are the measures in the SNF VBP Program the same as the measures in the SNF Quality Reporting Program (QRP) and on the Nursing Home Compare website?
      • How are performance scores calculated?
      • Will SNFs be able to calculate their achievement and improvement points?
      • How are incentive payments determined?
      • How will SNFs be notified of their performance in the Program?
      • What is Phase One of the Review and Corrections process?
      • How can I correct an error in my patient-level data?
      • What is Phase Two of the Review and Corrections process?
      • Where can I find more information or ask questions about the SNF VBP Program?
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  • SNF QRP Review and Correct Reports Now Available (4/19)

    By CMS - April 05, 2019

    The enhanced Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) review and correct reports are now available, on demand in the Certification and Survey Provider Enhanced Reporting (CASPER) application. In addition to enhanced sorting functionality, this report now includes patient level data and automated CSV file creation functionality that contains patient level results. 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.

    In addition to the sorting enhancements and inclusion of resident level data, these reports:

    • Contain quality measure information at the facility level
    • Allow providers to obtain aggregate performance for the past four quarters (when data is available)
    • Include data submitted prior to the applicable quarterly data submission deadlines
    • Display whether the data correction period for a given CY quarter is “open” or “closed.
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  • SNF QRP Q&A Document Targets Section N and Other issues (4/19)

    By CMS - April 05, 2019

    A new Question and Answer (Q+A) document is now available. The Q+A document reflects frequently asked questions that were received by the SNF QRP Help Desk during the fourth quarter (Oct - Dec) of 2018.

    ·        SNF QRP Quarterly FAQ Update Q4 2018 [PDF, 268KB]



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  • New Payment Models for Therapy Contracts

    By Mark McDavid, OTR, RAC-CT, CHC - March 27, 2019

    October 1 will be here before we know it. And with that comes Medicare’s new Patient-Driven Payment Model (PDPM) for beneficiaries accessing their SNF Part A benefit. It seems like every day there is a new webinar being advertised to help you understand all of the ins and outs of PDPM. It is definitely a more complex system than the RUG-IV system we operate under currently. As we analyze data collected in our facilities, trying to understand where we stand in a PDPM world, there is one other thing to consider: your therapy contract.

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  • CMS Early Findings Report: Initiative to Reduce Avoidable Hospitalizations in Nursing Facility Residents (3/19)

    By CMS - March 20, 2019

    Evaluation of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents – Payment Reform (NFI 2) Initiative Year 1 (FY 2017)

    CMS is pleased to share the second annual report of the “Evaluation of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents—Payment Reform.”

    Early findings in the report are preliminary and should not be considered conclusive. Nevertheless, the evaluation found some promising evidence that payment reforms have led to a consistent pattern of improved outcomes in newly-recruited facilities. Facilities that had participated in an earlier phase of the Initiative did not show further improvements beyond what was expected based on the trends established during that phase.

    For both groups, additional years of data and analysis should provide more definitive insight about Initiative effects.

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  • SNF Review and Correct Report Available (3/19)

    By QTSO - March 15, 2019

    SNF users were notified by CMS on Monday, March 11, that the Review and Correct report in the ‘SNF Quality Reporting Program ‘ category in the CASPER Reporting application would be unavailable while enhancements were being applied to the report. This report is now available and contains the following enhancements:

    • The addition of two new measures starting April 1, 2019:
     -Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury
     -Drug Regimen Review Conducted with Follow-up for Identified Issues – PAC SNF QRP
    • The removal of one measure starting with Q4 2018 results:
     -Percent of Residents or Patients with Pressure Ulcers That are New or Worsened (Short Stay) (NQF#0678)
    • The addition of Resident-Level data will now display with the Facility-Level data results.
     -A .csv file output will be available for the Patient-Level data
    • The Resident-Level and Facility-Level data will have new filter/sorting functionality within the CASPER Report Submit screen to customize the reporting results.

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  • ACO Insights From Trinity Health: A SNF Provider and ACO Executive Q&A

    By Caralyn Davis, Staff Writer - March 13, 2019

    For several years now, the Centers for Medicare & Medicaid Services (CMS) has been working to transform both payment and care delivery in the Medicare program. A key vehicle in the agency’s efforts is the Accountable Care Organization (ACO). 

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  • CASPER Reporting User’s Guide for MDS Providers UPDATED (3/19)

    By QTSO - March 11, 2019
    Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.
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  • SNF QRP Provider Threshold Report Finally Lets SNFs Track Data Submission Threshold Compliance (3/19)

    By QTSO - March 03, 2019

    The new Skilled Nursing Facility (SNF) Provider Threshold Report (PTR) is now available. This PTR is a user-requested, on demand report which enables users to obtain the status of their data submission completeness related to the compliance threshold required for the SNF Quality Reporting Program (QRP).

    Currently, Fiscal Year (FY) 2020 and FY2021 are available for user selection for this report to assist providers in reviewing Calendar Year (CY) 2018 and CY2019 data submission. The SNF PTR will display an asterisk (*) for future dates (monthly and quarterly) when a measure is active, but data are not available yet. 

    This report is available in the ‘SNF Quality Reporting Program’ category in the CASPER Reporting application. Please refer to Section 13-SNF Quality Reporting Program in the CASPER Reporting MDS Provider User’s Guide for additional information about this report.

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  • FY 2021 SNF QRP Program Data Collection & Final Submission Deadlines - Revised (2/19)

    By CMS - February 21, 2019

    Skilled Nursing Facility Quality Reporting Program Data Collection & Final Submission Deadlines for the FY 2021 SNF QRP

    This table provides the data collection time frames and final submission deadlines for the Fiscal Year (FY) 2021 Skilled Nursing Facility Quality Reporting Program (SNF QRP). The first column displays the measure name, the second column displays the data collection time frame, and the third column displays the final data submission deadlines.


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    • SNF QRP 3Q 2018 Help Desk Q+A Doc Includes 2 GG Coding Q&As (2/19)

      By CMS - February 19, 2019
      A new Question and Answer (Q+A) document is now available from the SNF Quality Reporting Program FAQs webpage. The Q+A document reflects frequently asked questions that were received by the SNF QRP Help Desk during the third quarter (July - September) of 2018. It includes information about the SNF QRP program, as well as two section GG coding questions (related to GG0170N and GG0170O).
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    • 7 Ways the DNS Can Lead the Charge for PDPM

      By Caralyn Davis, Staff Writer - February 12, 2019

      Many directors of nursing services (DNSs) have a hands-off approach when it comes to fee-for-service Medicare Part A and the MDS process, says Suzy Harvey, RN-BC, RAC-CT, managing consultant at BKD in Springfield, MO. “DNSs attend morning meetings and sometimes attend Medicare meetings, but they don’t really get involved because they count on their MDS staff to handle those processes.”


      That approach works for the RUG-IV case-mix classification system, but when the Skilled Nursing Facility Prospective Payment System (SNF PPS) switches to the Patient-Driven Payment Model (PDPM) on Oct. 1, rehabilitation therapy will no longer drive Part A skilled care, says Harvey. “With PDPM focused on patient characteristics and skilled nursing services instead of therapy volume, nursing will become key to facility success in this new system, and as the supervisor of the nursing staff, the DNS will need to help lead the way.”


      It’s important to note that working on PDPM isn’t just another task to add to the DNS’s plate, adds Harvey. “Getting paid appropriately is the focus of PDPM, but it ties back into quality of care. Much of what you will need to work on for PDPM will also benefit you on survey and your quality measures as well.”


      Here are seven key steps a DNS can take to get out in front of PDPM:

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    • SNF QRP Nursing Home Compare Updated W/ 1Q 2018 Data (1/19)

      By CMS - February 01, 2019

      The January 2019 Nursing Home Compare Refresh, including quality measure results based on SNF QRP data submitted to CMS, is now available.

      The updated SNF quality measure results are based on data submitted to CMS between:

      1.     Quarter 2 – 2017 to Quarter 1 – 2018 data

      o   Application of Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay) (#0674)

      o   Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short Stay) (NQF #0678)

      o   Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (#2631)

      2.     Quarter 4 – 2016 to Quarter 3 – 2017 data

      o   Medicare Spending Per Beneficiary – Post-Acute Care (PAC) Skilled Nursing Facility Measure

      o   Discharge to Community- Post Acute Care (PAC) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)

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    • Are You Taking the Right Steps to Build Census?

      By Caralyn Davis, Staff Writer - January 29, 2019

      These days, nursing homes face census pressures on multiple fronts. “Some issues are beyond the control of the director of nursing services (DNS),” says Carol Hill, MSN, RN, RAC-MT, DNS-MT, QCP-MT, CPC, president of Hill Educational Services in Warrior, AL. “For example, when census is low at the hospital and referrals simply aren’t out there or when you have trouble hiring staff because your local labor market is extremely tight, you can’t do much about it.”


      However, no matter what outside forces are at play, a DNS still has the opportunity to maximize census, notes Hill. “On the positive side, it’s not a stand-alone endeavor that just adds one more job to the DNS’s task list. Boosting census requires looking at the total picture, so a lot of what you will do to improve census also will benefit your Quality Measures in the different programs, as well as your survey performance.”


      The following steps can help providers get on the right track.

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