You Are Here:Home/Resources/Billing and Payment Initiatives/Billing and Payment Initiatives Details
The scope and duration of the exception under each Medicare quality reporting program is described below; however, all of the exceptions are being granted to assist these providers while they direct their resources toward caring for their patients and repairing structural damages to facilities.
The rules provide greater flexibility for healthcare providers to participate in value-based arrangements and to provide coordinated care for patients. The final rules also ease unnecessary compliance burden for healthcare providers and other stakeholders across the industry, while maintaining strong safeguards to protect patients and programs from fraud and abuse.
The HHS Office of Inspector General (OIG) issued the final rule “Revisions to the Safe Harbors Under the Anti-Kickback Statute and Civil Monetary Penalty Rules Regarding Beneficiary Inducements,” and the Centers for Medicare and Medicaid Services (CMS) issued the final rule “Modernizing and Clarifying the Physician Self-Referral Regulations.” These rules are part of HHS’s Regulatory Sprint to Coordinated Care, which has examined federal regulations that potentially impede healthcare providers’ efforts that otherwise would advance the transition to value-based care and improve the coordination of patient care across care settings in Federal healthcare programs and the commercial sector. In addition to advancing value-based care, the CMS final rule clarifies and modifies existing policies to ease unnecessary regulatory burden on physicians and other healthcare providers while reinforcing the physician self-referral law’s (often called the “Stark Law”) goal of protecting patients from unnecessary services and being steered to less convenient, lower quality, or more expensive services because of a physician’s financial self-interest.
The new and amended regulations related to the federal Anti-Kickback statute and the civil monetary penalties law issued by OIG address stakeholder concerns that these laws unnecessarily limit the ways in which healthcare providers can coordinate care with and for federal healthcare program beneficiaries. OIG’s final rule modifies and clarifies the agency’s proposed rule in response to comments, as explained in the preamble to the final rule.
For example, OIG’s final rule clarifies how medical device manufacturers and durable medical equipment companies may participate in protected care coordination arrangements that involve digital health technology, and the final rule lowers the level of “downside” financial risk parties must assume to qualify under the new safe harbor for value-based arrangements that involve substantial downside financial risk. In recognition of the urgent problem of cyber threats to the healthcare industry, the rule also broadens the new safe harbor for cybersecurity technology and services to protect cybersecurity-related hardware.
OIG’s final rule, and the CMS final rule to the extent the Stark Law is applicable, would facilitate a range of arrangements to improve the coordination and management of patient care and the engagement of patients in their treatment if all applicable regulatory conditions are met, including the following examples:
The October 2020 refresh of SNF QRP data is now available on Nursing Home Compare (NHC), as well as the Nursing homes including rehab services web pages within Care Compare (CCXP) and Provider Data Catalog (PDC).
The data are based on quality assessment data submitted by SNFs to CMS from Quarter 1 2019 through Quarter 4 2019 (01/01/2019 –12/31/2019); and the annual update of the claims-based measures data from Quarter 4 2017 – Quarter 3 2019 (10/01/2017 – 9/30/2019).
Starting in October 2020, six additional SNF QRP measures will be publicly reported on NHC, CCXP and PDC:
· Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury,
· Drug Regimen Review Conducted with Follow-Up for Identified Issues – PAC SNF QRP,
· Application of IRF Functional Outcome Measure: Change in Self-Care (NQF #2633),
· Application of IRF Functional Outcome Measure: Change in Mobility (NQF #2634),
· Application of IRF Functional Outcome Measure: Discharge Self-Care Score (NQF #2635), and
· Application of IRF Functional Outcome Measure: Discharge Mobility Score (NQF #2636).
The SNF QRP Measure Calculations and Reporting User’s Manual Version 3.0.1 addendum and associated risk adjustment appendix and Hierarchical Condition Category (HCC) crosswalks are now available.
This ZIP file includes:
SNF Quality Reporting Program (QRP) quality data on Nursing Home Compare are updated on a quarterly basis. All data displayed on NH Compare (Skilled Nursing Facility and Nursing Home) include demographic information, such as address, telephone number, and ownership. This demographic data is generated from the information stored in the Automated Survey Processing Environment (ASPEN) system.
Below are the steps to guide providers on how to verify and update Skilled Nursing Facility demographic data.
It is important for providers to review their SNF QRP Preview Reports to verify that the demographic data is accurate. SNF QRP Preview Reports reflect the quality measure data and facility/provider demographic information that will be posted to NH Compare in the following quarter. SNF QRP Preview Reports are available in providers’ shared folder in the Centers for Medicare & Medicaid Services (CMS) designated data submission system, Certification and Survey Provider Enhanced Reporting (CASPER) during the 30-day preview windows prior to the quarterly NH Compare refreshes.
If inaccurate or outdated demographic data is included on the SNF QRP Preview Report or on NH Compare, SNFs need to contact their Medicare Administrative Contractor (MAC) for assistance. When requesting updates to your demographic data, it is important to ask that the MAC send the updated 855A (provider enrollment form) to the CMS Regional Offices in order to update the ASPEN data. Changes to demographic data must be updated and uploaded to the national database via ASPEN in order for the Compare site to be updated.
When requesting updates to demographic data, it is important to ask for updates to the data within the ASPEN system, and not the data on the Compare site.
Please note - updates to demographic information do not happen in real-time and can take up to 6-months to appear on NH Compare. If you encounter difficulty reaching your MAC, or for assistance accessing SNF QRP provider preview reports, please contact the QTSO Help Desk at 1-800-339-9313 or email@example.com.
The FY 2021 SNF PPS Proposed Rule was a shadow of what the Centers for Medicare & Medicaid Services (CMS) had planned due to the ongoing coronavirus 2019 (COVID-19) public health emergency. So it's no surprise that the final rule, Medicare Program: Prospective Payment System (PPS) and Consolidated Billing for Skilled Nursing Facilities (SNFs); Updates to the Value-Based Purchasing Program for Federal Fiscal Year (FY) 2021 (CMS-1737-F), finalizes most, if not quite all, of the proposals without modification. And while COVID-19 caused some changes to the payment rate calculations, CMS cited commenters' requests for additional relief from COVID-19 as beyond the scope of this rulemaking.
Here are some of the key updates that directors of nursing services (DNSs) should pay attention to:
To access this resource, please login or sign up for a membership.