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 - October 15, 2019
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  • SNF QRP: 2Q 2019 FAQs (10/19)

    By CMS - October 13, 2019
    A new Question and Answer (Q+A) document is now available in the "Downloads" section of 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 second quarter (Apr - Jun) of 2019.
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  • CASPER Reporting User’s Guide for MDS Providers UPDATED (9/19)

    By QTSO - September 30, 2019
    Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.
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  • SNF QRP Measure Calculations and Reporting User's Manual Update (9/19)

    By CMS - September 05, 2019

    The Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0 has been posted. The Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 3.0 contains detailed specifications for the assessment- and claims-based quality measures reported under the SNF QRP. The manual can be found below and the Skilled Nursing Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual Version 2.0 has been moved to the Quality Measures Archive page.

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  • 2020 ICD-10-CM Diagnosis Code Files and Coding Guidelines (8/19)

    By CMS - August 12, 2019
    The 2020 ICD-10-CM files  contain information on the ICD-10-CM updates for FY 2020. These 2020 ICD-10-CM codes are to be used for discharges occurring from October 1, 2019 through September 30, 2020 and for patient encounters occurring from October 1, 2019 through September 30, 2020. This also contains the official ICD-10 Coding Guidelines.
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  • PDPM At-a-Glance Tool

    By AANAC - August 07, 2019
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  • SNF QRP: SPADEs and New QMs That Begin Data Collection on Oct. 1, 2020

    By MX - August 01, 2019

    Change tables, MDS mockups, and data specifications.

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  • FY 2020 SNF PPS Final Rule Link and Fact Sheet (7/19)

    By CMS - July 30, 2019

    The Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1718-F] for Fiscal Year (FY) 2020 Medicare payment rates and quality programs for skilled nursing facilities (SNFs). This final rule is part of the agency’s 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. The final rule [CMS-1718-F] can be downloaded from the Federal Register at: https://www.federalregister.gov/documents/2019/08/07/2019-16485/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities.

    OVERVIEW

    This fact sheet discusses three major provisions of the final rule:

    ·        SNF payment policy under the SNF Prospective Payment System (PPS)

    ·        SNF Value-Based Purchasing Program (VBP)

    ·        SNF Quality Reporting Program (QRP). 

    This final rule includes policies that continue to move forward agency commitments to shift Medicare payments from volume to value, with the continued implementation of the SNF VBP and SNF QRP to improve program interoperability, operational quality and safety.

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  • CMS May 7 and 8, 2019, SNF QRP Post-Training Videos and Slide Sets Available (7/19)

    By CMS - July 29, 2019

    Videos and post-training materials (includes answers to knowledge checks and interactive sessions) from the May 2019 Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Provider Training held in Kansas City, MO, on May 7 and 8, 2019, are now available.

    Please note: Post-training materials include answers to knowledge checks and interactive sessions. Additionally, Section GG presentation has been updated to include links to videos shown during the training.

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  • 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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