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 Home Compare 2019 Anticipated Refreshes and Data Collection Timeframes for SNF QRP QMs (6/19)

    By CMS - June 16, 2019

    This table provides the data collection timeframes for quality measures in the Skilled Nursing Facility Quality Reporting Program (SNF QRP) displayed on the Nursing Home Compare website for Calendar Year (CY) 2019. The first column displays the plain language measure name used on the Compare website, the second column displays the full technical measure name, the third column displays the reporting cycle which describes the collection period and refresh frequency, and the last four columns contain the timeframe for each quarterly Compare website refresh.

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  • FY 2021 SNF QRP Table for Reporting Assessment-Based Measures (6/19)

    By CMS - June 11, 2019
    The SNF QRP Table for Reporting Assessment-Based Measures for the FY 2021 SNF QRP APU is now available for download on the Skilled Nursing Facility (SNF) Quality Reporting Program Measures and Technical Information webpage. This table indicates the MDS data elements that are used in determining the APU minimum submission threshold for the FY 2021 SNF QRP determination.
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  • SNF QRP: Updates to SNF Provider Preview Reports (6/19)

    By QTSO - June 03, 2019

    Effective 6/1/19, there will be enhancements to the upcoming Provider Preview Reports. The next SNF Provider Preview Report is scheduled for August 1, 2019. The updates will include:

    • Pressure Ulcer Measure Transition

     -The current pressure ulcer measure, Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short Stay) (NQF #0678), will last appear on the May 2019 SNF Provider Preview Report. Starting August 1, 2019, this measure will be removed.
     -The new pressure injury measure, Changes in Skin Integrity Post-Acute Care, will first display on the August 2020 Provider Preview Report.

    • Ending suppression of the PPR claims-based measure:  
     -Potentially Preventable 30-Day Post-Discharge Readmission Measure for Inpatient Rehabilitation Facility Quality Reporting Program
    • Displaying measure short names in place of their long names and many aesthetic changes to field labels and headings.

    • Update of the Discharge to Community Measure  
     -The refined measure results for the Discharge to Community Measure will be reflected for the first time in the fall 2019 Quarterly Refresh for the Nursing Home Compare website and the related August 2019 Provider Preview Reports.

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  • October 2019 SNF QRP Change: Update of the Discharge to Community Claims-based Measure (5/19)

    By CMS - June 03, 2019

    The DTC-PAC measure was first displayed on the Nursing Home Compare website in fall 2018 and will be refreshed in fall 2019. CMS has refined the statistical methodology for assigning providers to performance categories for public display to align with the Potentially Preventable Readmissions measures in the PAC QRPs and the Hospital-Wide Readmission measure in the Inpatient QRP. This refinement results in greater variation in provider performance categories, allowing better discernment of providers that underperform or overperform considerably compared with the national rate. The refinement will be reflected for the first time in the fall 2019 Quarterly Refresh for the Nursing Home Compare website, and the related August 2019 Provider Preview Reports.

    Background

    ·        The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) directed the Secretary to specify and publicly report measures reflecting successful discharge to community for use in the SNF QRP.

    ·        The SNF QRP DTC measure was finalized in the Fiscal Year 2017 SNF PPS Final Rule. Confidential feedback reports were distributed to SNF providers in fall 2017 and the measures were first displayed on the Nursing Home Compare website in fall 2018.

    ·        For the fall 2019 public display refresh of the DTC measure, and in future years, CMS has refined the method by which we assign providers to performance categories to align with the claims-based Potentially Preventable Readmissions measures in the SNF QRP and the Hospital-Wide Readmission measure in the Inpatient QRP.

    ·        Our revised methodology results in greater variation in performance categories, allowing better discernment of provider performance, including those that underperform or overperform considerably compared with the national rate. This refinement will be reflected in the fall 2019 Quarterly Refresh of the Nursing Home Compare website, as well as the August 2019 SNF Provider Preview Reports.

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  • October 2019 SNF QRP Change: Public Reporting of Potentially Preventable 30-Day Post-Discharge Readmissions Measure (5/19)

    By CMS - May 31, 2019
    Beginning fall 2019, CMS will publicly display measure results on Nursing Home Compare for the Potentially Preventable 30-Day Post-Discharge Readmissions Measure adopted for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). CMS postponed publishing this measure in late 2018 to allow more testing to ensure it provides a reliable, accurate picture of provider performance on quality, in line with CMS’s Meaningful Measures Initiative to address high-priority areas for quality measurement with measures that will help improve patient outcomes while minimizing provider burden. CMS has since completed this additional testing and have refined the method for assigning providers to performance categories, in which their performance level is compared to the national rate.

    CMS has released two key documents in conjunction with this announcement:  FAQS for Potentially Preventable Readmission Measures for the Post-Acute QRPs and Fact Sheet  for Potentially Preventable Readmission Measures for the Post-Acute QRPs.

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  • SNF VBP: SNFRM Technical Report Supplement Update (5/19)

    By CMS - May 29, 2019

    The SNF VBP Program awards incentive payments to SNFs based on their performance on the SNF 30-Day All-Cause Readmission Measure (SNFRM; NQF #2510). The SNFRM measures the rate of all-cause, unplanned hospital readmissions for SNF residents within 30 days of discharge from a prior hospital stay. The SNFRM is risk adjusted for stay-level factors including clinical and demographic characteristics. Each SNF receives a SNFRM score for a baseline period and a performance period. 

    CMS has issued a supplement update to the SNFRM Technical Report, as well as a planned readmission algorithm.

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  • SNF VBP Home Page Created(5/19)

    By CMS - May 22, 2019
    CMS has created a new online home for the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program with the following sections:

    • Measure
    • Scoring Methodology & Payment Adjustment
    • Confidential Feedback Reporting & Review and Corrections
    • Extraordinary Circumstance Exception
    • Public Reporting of SNF VBP Program Data
    • Resources

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  • May 7 - 8 SNF QRP Training Materials Available

    By CMS - May 02, 2019
    May 7 - 8 SNF QRP Training Materials Available
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  • SNF QRP FY 2020 Reconsideration Request Process Estimated Timeline (5/19)

    By CMS - May 01, 2019
    The estimated CMS reconsideration process timeline for FY 2020 payment determination.
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  • FY 2020 and FY 2021 SNF QRP Program Data Collection & Final Submission Deadlines (5/19)

    By CMS - April 23, 2019

    Skilled Nursing Facility Quality Reporting Program Data Collection & Final Submission Deadlines for the FY 2020 and FY 2021 SNF QRP

    These two tables provide the data collection time frames and final submission deadlines for the Fiscal Year (FY) 2021 Skilled Nursing Facility Quality Reporting Program (SNF QRP) and FY 2021 SNF QRP. The first column  in each table 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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    • FY 2020 SNF PPS Proposed Rule (4/19)

      By CMS - April 19, 2019

      Proposed Fiscal Year 2020 Payment and Policy Changes for Medicare Skilled Nursing Facilities (CMS-1718-P)

      On April 19, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule [CMS-1718-P] for Fiscal Year (FY) 2020 that updates the Medicare payment rates and the quality programs for skilled nursing facilities (SNFs). This proposed rule is part of our continuing efforts to strengthen the Medicare program by better aligning payment rates for these facilities with the costs of providing care and increasing transparency so that patients are able to make informed choices.  Additionally, effective October 1, 2019, CMS will begin using a new case-mix model, the Patient Driven Payment Model (PDPM), which focuses on the patient’s condition and resulting care needs rather than on the amount of care provided in order to determine Medicare payment.

      This fact sheet discusses three major provisions of the proposed rule: the proposed changes to SNF payment policy under the SNF Prospective Payment System (PPS), the SNF Value-Based Purchasing Program (VBP), and the SNF Quality Reporting Program (QRP).  This proposed rule includes policies that would continue a commitment to shift Medicare payments from volume to value, with the continued implementation of the PDPM, SNF VBP, and SNF QRP to improve program interoperability, operational quality and safety.

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    • At A Glance QM, QRP, and VBP Tool

      By AADNS - April 18, 2019
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    • CMS SNF VBP FAQs UPDATED (4/19)

      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]

       

      From https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-FAQs-.html

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