SNF Quality Reporting Program (QRP) Submission Deadline Reminder

SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. MDS and NHSN data for 10/1/21 through 12/31/21 must be submitted no later than 11:59 p.m. on May 16, 2022.

The Minimum Data Set (MDS) 3.0 must be transmitted to the Centers for Medicare & Medicaid Services (CMS) through the Assessment Submission and Processing (ASAP) system to the Quality Improvement Evaluation System (QIES). Data for the National Healthcare Safety Network (NHSN) measures must be submitted to the Centers for Disease Control and Prevention (CDC). No additional data submission is required for the claims-based measures.

As a reminder, it is recommended that providers run applicable CASPER reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

Swingtech sends informational messages to SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@swingtech.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

More information about SNF QRP can be found on the following webpages:

Payroll-Based Journal (PBJ) Submission Deadline Reminder

Nursing homes are required to electronically submit direct care staffing information to the Payroll-Based Journal (PBJ) system. Submissions must be received by the end of the 45th calendar day (11:59 PM Eastern Standard Time) after the last day in each fiscal quarter to be considered timely. PBJ data for 1/1/22 through 3/31/22 is due May 15, 2022. Please submit PBJ data as soon as possible to avoid delays. CMS recommends running staffing reports in CASPER prior to the submission deadline to ensure the accuracy and completeness of submissions. Please remember, the Final File Validation Report verifies that the submission was successful.

Please note: If you need assistance with the PBJ quarterly submission and the deadline falls on a weekend, you must contact the QIES/iQIES Service Center no later than the Friday before the submission deadline, as the Service Center will be unavailable to assist on the weekend.

More information about PBJ can be found on the following webpages:

SNF Quality Reporting Program (QRP) Submission Deadline Reminder

SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. MDS data for 7/1/21 through 6/30/21 must be submitted no later than 11:59 p.m. on February 15, 2022.

The Minimum Data Set (MDS) 3.0 must be transmitted to CMS through the Assessment Submission and Processing (ASAP) system to the Quality Improvement Evaluation System (QIES). No additional reporting is required.

As a reminder, it is recommended that providers run applicable CASPER reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

Swingtech sends informational messages to SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@swingtech.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

More information about SNF QRP can be found on the following webpages:

Payroll-Based Journal (PBJ) Submission Deadline Reminder

Nursing homes are required to electronically submit direct care staffing information to the Payroll-Based Journal (PBJ) system. Submissions must be received by the end of the 45th calendar day (11:59 PM Eastern Standard Time) after the last day in each fiscal quarter to be considered timely. PBJ data for 10/1/21 through 12/31/21 is due February 14, 2022. Please submit PBJ data as soon as possible to avoid delays. CMS recommends running staffing reports in CASPER prior to the submission deadline to ensure the accuracy and completeness of submissions. Please remember, the Final File Validation Report verifies that the submission was successful.

Please note: If you need assistance with the PBJ quarterly submission and the deadline falls on a weekend, you must contact the QIES/iQIES Service Center no later than the Friday before the submission deadline, as the Service Center will be unavailable to assist on the weekend. More information about PBJ can be found on the following webpages:

SNF Quality Reporting Program (QRP) Submission Deadline Reminder

SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. MDS data for 4/1/21 through 6/30/21 must be submitted no later than 11:59 p.m. on November 15, 2021.

The Minimum Data Set (MDS) 3.0 must be transmitted to CMS through the Assessment Submission and Processing (ASAP) system to the Quality Improvement Evaluation System (QIES). No additional reporting is required.

As a reminder, it is recommended that providers run applicable CASPER reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

Swingtech sends informational messages to SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@swingtech.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

More information about SNF QRP can be found on the following webpages:

Payroll-Based Journal (PBJ) Submission Deadline Reminder

Nursing homes are required to electronically submit direct care staffing information to the Payroll-Based Journal (PBJ) system. Submissions must be received by the end of the 45th calendar day (11:59 PM Eastern Standard Time) after the last day in each fiscal quarter to be considered timely. PBJ data for 7/1/21 through 9/30/21 is due November 14, 2021. Please submit PBJ data as soon as possible to avoid delays. CMS recommends running staffing reports in CASPER prior to the submission deadline to ensure the accuracy and completeness of submissions. Please remember, the Final File Validation Report verifies that the submission was successful.

Please note: If you need assistance with the PBJ quarterly submission and the deadline falls on a weekend, you must contact the QIES/iQIES Service Center no later than the Friday before the submission deadline, as the Service Center will be unavailable to assist on the weekend. Therefore, phone and email support will be concluded as of Friday, November 12, 2021 at 8:00 p.m. (ET).More information about PBJ can be found on the following webpages:

RAI Manual Updates

CMS released a PDF file labeled “MDS 3.0RAIManualv1.17.1R.Errata.October.1.2021,” available in the Downloads section of the MDS 3.0 RAI Manual webpage. This file contains revisions to pages in Chapter 6 of the MDS 3.0 RAI Manual v1.17.1R that update the NTA Comorbidity Score Calculation table. Changed manual pages are marked with the footer “October 2019 (R).” The errata document begins with a table that lists all identified revisions and the pages to which they have been applied. Following the table are the actual corrected replacement pages for insertion into the printed manual.

Payroll-Based Journal (PBJ) Submission Deadline Reminder

Nursing homes are required to electronically submit direct care staffing information to the Payroll-Based Journal (PBJ) system. Submissions must be received by the end of the 45th calendar day (11:59 PM Eastern Standard Time) after the last day in each fiscal quarter to be considered timely. PBJ data for 4/1/21 through 6/30/21 is due August 14, 2021. Please submit PBJ data as soon as possible to avoid delays. CMS recommends running staffing reports in CASPER prior to the submission deadline to ensure the accuracy and completeness of submissions. Please remember, the Final File Validation Report verifies that the submission was successful.

PLEASE NOTE: If you need assistance with the PBJ quarterly submission and the deadline falls on a weekend, you must contact the QIES/iQIES Service Center no later than the Friday before the submission deadline. The Service Center will be unable to assist on the weekend. Therefore, phone and email support will be concluded as of Friday August 13, 2021 at 8:00 p.m. (ET).

More information about PBJ can be found on the following webpages:

SNF Quality Reporting Program (QRP) Submission Deadline Reminder

SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. MDS data for 1/1/21 through 3/31/21 must be submitted no later than 11:59 p.m. on August 16, 2021.

The Minimum Data Set (MDS) 3.0 must be transmitted to CMS through the Assessment Submission and Processing (ASAP) system to the Quality Improvement Evaluation System (QIES). No additional reporting is required.

As a reminder, it is recommended that providers run applicable CASPER reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

Swingtech sends informational messages to IRFs, LTCHs, and SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@swingtech.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

More information about SNF QRP can be found on the following webpages:

Quality Reporting Program: Non-Compliance Letters for FY 2022 APU

CMS is providing notifications to facilities that were determined to be out of compliance with Quality Reporting Program (QRP) requirements for CY 2020, which will affect their FY 2022 Annual Payment Update (APU). Non-compliance notifications are being distributed by the Medicare Administrative Contractors (MACs) and were placed into SNFs’ CASPER folders in QIES on July 14, 2021. Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 pm, August 13, 2021.

If you receive a notice of non-compliance and would like to request a reconsideration, see the instructions in your notice of non-compliance and on the SNF Quality Reporting Reconsideration and Exception & Extension webpage.

SNF Quality Reporting Program (QRP) Submission Deadline Reminder

SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. MDS data for October 1 – December 31 (Q4) of CY 2020 must be submitted no later than 11:59 p.m. on May 17, 2021.

The Minimum Data Set (MDS) 3.0 must be transmitted to CMS through the Assessment Submission and Processing (ASAP) system to the Quality Improvement Evaluation System (QIES). No additional reporting is required.

As a reminder, it is recommended that providers run applicable CASPER reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

Swingtech sends informational messages to IRFs, LTCHs, and SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@swingtech.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

More information about SNF QRP can be found on the following webpages:

Payroll-Based Journal (PBJ) Submission Deadline Reminder

Nursing homes are required to electronically submit direct care staffing information to the Payroll-Based Journal (PBJ) system. Submissions must be received by the end of the 45th calendar day (11:59 PM Eastern Standard Time) after the last day in each fiscal quarter to be considered timely. PBJ data for 1/1/21 through 3/31/21 is due on Saturday, May 15, 2021. Please submit PBJ data as soon as possible to avoid delays. CMS recommends running staffing reports in CASPER prior to the submission deadline to ensure the accuracy and completeness of submissions. Please remember, the Final File Validation Report verifies that the submission was successful.

Please note: If you need assistance with the PBJ quarterly submission and the deadline falls on a weekend, you must contact the QIES/iQIES Service Center (1-800-339-9313) no later than the Friday before the submission deadline as the Service Center will be unavailable to assist on the weekend.

More information about PBJ can be found on the following webpages:

SNF Quality Reporting Program (QRP) Submission Deadline Reminder

SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. MDS data for July 1 – September 30 (Q3) of CY 2020 must be submitted no later than 11:59 p.m. on February 16, 2021.

The Minimum Data Set (MDS) 3.0 must be transmitted to CMS through the Assessment Submission and Processing (ASAP) system to the Quality Improvement Evaluation System (QIES). No additional reporting is required.

As a reminder, it is recommended that providers run applicable CASPER reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

Swingtech sends informational messages to IRFs, LTCHs, and SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@swingtech.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

More information about SNF QRP can be found on the following webpages:

Payroll-Based Journal (PBJ) Submission Deadline Reminder

Nursing homes are required to electronically submit direct care staffing information to the Payroll-Based Journal (PBJ) system. Submissions must be received by the end of the 45th calendar day (11:59 PM Eastern Standard Time) after the last day in each fiscal quarter to be considered timely. PBJ data for 10/1/20 through 12/31/20 is due on Sunday, February 14, 2021. Please submit PBJ data as soon as possible to avoid delays. CMS recommends running staffing reports in CASPER prior to the submission deadline to ensure the accuracy and completeness of submissions. Please remember, the Final File Validation Report verifies that the submission was successful.

Please note: If you need assistance with the PBJ quarterly submission and the deadline falls on a weekend, you must contact the QIES/iQIES Service Center (1-800-339-9313) no later than the Friday before the submission deadline as the Service Center will be unavailable to assist on the weekend.

More information about PBJ can be found on the following webpages:

MDS Changes for 10-1-20

Missouri opted to collect PDPM HIPPS codes on OBRA assessments with an ARD of 10/1/20 or later. This means that SNFs and NFs in Missouri need to complete additional items on OBRA assessments not combined with a Medicare assessment. Additional items include:

  • GG0130 Self-Care items;
  • GG0170 Mobility items;
  • I0020 and I0020B Primary Medical Condition items;
  • J2100 Recent Surgery item. If J2100 is checked yes, J2300-J5000 are to be completed.

Training: QIPMO provided a webinar on 9/21/20 where Stacey Bryan, Missouri’s State RAI Coordinator, went over MDS changes for 10-1-20. To view a recording of this webinar please go to https://nursinghomehelp.org/event/september-monthly-webinar/. Please note, the RAI Manual pages to review for examples of diagnoses in each medical condition category for item I0020 is I-2 and I-3, not I-12 which is referenced in the webinar.

FAQ Document: Below is a FAQ document concerning the MDS changes for Missouri this October. This document will be updated as needed. The date a question and answer is added to the document will be beneath each answer.

MDS FAQ Document for MO 10-16-20 version

If you have any questions about this information please contact Missouri’s State RAI Coordinator, Stacey Bryan, at Stacey.Bryan@health.mo.gov or 573-751-6308.

MDS Rejections related to October 2020 Changes

Missouri opted to collect PDPM HIPPS codes on OBRA assessments with an ARD of 10/1/20 or later. This means that SNFs and NFs in Missouri need to complete additional items on OBRA assessments not combined with a Medicare assessment. Additional items include:

  • GG0130 Self-Care items;
  • GG0170 Mobility items;
  • I0020 and I0020B Primary Medical Condition items;
  • J2100 Recent Surgery item. If J2100 is checked yes, J2300-J5000 are to be completed.

Multiple homes have reported their software has not incorporated the additional required items listed above for OBRA comprehensive and Quarterly assessments with an ARD of 10/1/20 or after. They report if they complete the MDS assessments without these items the assessments are rejected by the QIES ASAP system. Some homes report they are able to change a setting in their software themselves that will include these items on OBRA assessments. Some homes report they cannot change the setting in the software themselves, that they must contact their software vendor for this setting change. Most homes that encounter this issue say after their software setting is changed, they must open completely new MDS assessments because the additional items will not be added to the assessment they opened prior to the setting change.

If you are completing an OBRA comprehensive or Quarterly assessment that has an ARD on or after 10/1/20, please ensure the additional items listed above, required to calculate a PDPM HIPPS code, are NOT grayed out in your software. If you discover these items are grayed out, contact your software vendor as soon as possible before continuing with the assessment.

If you have any questions about this issue please contact Stacey Bryan at Stacey.Bryan@health.mo.gov or 573-751-6308. Thank you.

Coding GG0130 Self-Care and GG0170 Mobility items on an OBRA MDS assessment not combined with a Medicare MDS Assessment

This document was created to assist NHs in Missouri with coding GG0130 and GG170 items on OBRA MDS assessments not combined with a Medicare assessment. All of the guidance contained in this document comes from the Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User’s Manual Version 1.17.1.

SNF Patient Driven Payment Model (PDPM) Interrupted Stay Billing Issue

A new issue is affecting some inpatient hospital and Skilled Nursing Facility (SNF) claims when an interrupted stay is billed at the end of the month. The system incorrectly assigns edits U5601-U5608 (overlapping a hospital claim). If you billed the interrupted stay correctly, and your claim is rejected, modify your billing so the claim spans past the last day of the interrupted stay:

  • Bill two months at a time, or
  • Bill a month plus the days in the following month that span the interrupted stay plus 1 day

Adjusting the statement covered from and through dates to encompass the entire interrupted stay will allow your claim to process and pay correctly. Medicare Administrative Contractors will finalize any suspended claims that meet the criteria, so you can make corrections and resubmit your claim.

If we rejected an inpatient hospital claim, the hospital should ask the SNF to modify their claim. Until October 5, a SNF cannot submit an adjustment to a paid claim; they must cancel the paid claim and all subsequent claims in the same stay and resubmit them in sequential order.

CMS will correct the system in the future.

MDS Final Item Sets (Version 1.17.2) for October 1, 2020

In response to State Medicaid Agency and stakeholder requests, CMS has updated the MDS 3.0 item sets (version 1.17.2) and related technical data specifications. These changes will support the calculation of PDPM payment codes on OBRA assessments when not combined with the 5-day SNF PPS assessment, specifically the OBRA comprehensive (NC) and OBRA quarterly (NQ) assessment item sets, which was not possible with item set version 1.17.1. This will allow State Medicaid Agencies to collect and compare RUG-III/IV payment codes to PDPM ones and thereby inform their future payment models.

The changes to the technical data specifications that support these modifications are contained in the Errata v3.00.5 which can be accessed in the file: MDS 3.0 data specs errata (v3.00.5) Final 06-18-2020 in the Downloads section of the MDS 3.0 Technical Information page. Supporting materials including the 1.17.2 Item Change History report and the revised 1.17.2 Item Sets can be accessed in the file: MDS 3.0 Final Item Sets v1.17.2 for October 1 2020 zip, which are also posted in the Downloads section of the MDS 3.0 Technical Information page.

The Department of Social Services (DSS) is required to submit a Medicare Upper Payment Limit (UPL) Demonstration for nursing facilities to CMS at the end of each state fiscal year. Currently, the Missouri nursing facility UPL Demonstration is based on the Medicare Resource Utilization Groups (RUGs) reimbursement system and the associated MDS data. With Medicare’s change in reimbursement to PDPM, CMS has indicated that at some point RUGs calculations will no longer be supported. At that point, or perhaps sooner, the State anticipates transitioning the UPL Demonstration to be based on the PDPM payment methodology that Medicare now uses. DSS will need the additional data items to perform that calculation. This will allow DSS to continue to align the UPL calculation to most closely reflect the Medicare payment methodology. The DSS may also use the additional data for future acuity-based analysis that would require these data elements.

Since Missouri will require the calculation of the PDPM payment codes on the OBRA assessments when not combined with a 5-day SNF PPS assessment, SNFs and NFs in Missouri will need to complete additional items on OBRA assessments when not combined with a 5-day SNF PPS assessment. Additional items include:

  • GG0130 Self-Care items;
  • GG0170 Mobility items;
  • I0020 and I0020B Primary Medical Condition items;
  • J2100 Recent Surgery item. If J2100 is checked yes, J2300-J5000 are to be completed.

Coding instructions for these items on OBRA assessments when not combined with a 5-day SNF PPS assessment will be forthcoming so stay tuned.

Quality Reporting Program: Non-Compliance Letters for FY2021 APU

CMS is providing notifications to SNFs that were determined to be out of compliance with Quality Reporting Program (QRP) requirements for CY 2019, which will affect their FY 2021 Annual Payment Update (APU). Non-compliance notifications are being distributed by the Medicare Administrative Contractors (MACs) and were also placed into facilities’ CASPER folders in QIES on July 13, 2020. Either notification is official notice of non-compliance. Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 pm, August 18, 2020.

If you receive a notice of non-compliance and would like to request a reconsideration, see the instructions in your notice of non-compliance and on the SNF Quality Reporting Reconsideration and Exception & Extension webpage.

CMS Answers Frequently asked Medicare Fee-for Service Billing Questions related to the COVID-19

Please see the document found on the CMS Current Emergencies webpage at https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page under the Billing and Coding Guidance section. Information related exclusively to SNFs can be found on pages 34 and 35 but there may be other pertinent information to SNFs found throughout the document.

SNF Claims Incorrectly Cancelled

From January 26 through February 16, 2020, a software issue caused Skilled Nursing Facility (SNF) claims to be incorrectly cancelled with a message that there was no three day qualifying hospital stay. This issue is corrected. If your claims were incorrectly cancelled, re-bill them in sequential order to receive payment.

Note:

  • Claims need to process in date of service order for each stay for the Variable Per Diem (VPD) to calculate correctly
  • Submit claims in sequence and wait at least 2 weeks before billing subsequent claims
  • Some of the affected claims with older dates of service will require a timely filing exception; enter “Resubmission due to non-qualifying stay” in the remarks field
  • This issue was not caused by the recent implementation of the SNF Patient Driven Payment Model
  • Contact your MAC to receive the Medicare Beneficiary Identifier (MBI) for deceased beneficiaries

MLN Matters Bulletin Revised 3-18 -20 Medicare FFS Respnose to COVID-19

MDS 3.0 RAI Manual – Delayed

March 19, 2020

CMS is delaying the Minimum Data Set (MDS) 3.0 v1.18.1 release, which had been scheduled for October 1, 2020, in response to stakeholder concerns. The MDS item sets are used by Nursing Home and Swing Bed providers to collect and submit patient data to CMS. This MDS data informs payment, quality, and the survey process.

In December of 2019, CMS posted a draft of the MDS 3.0 item set v1.18.0 and received feedback from our stakeholders. We would like to thank the stakeholders for sharing their concerns regarding the proposed changes to the MDS 3.0 item sets and more specifically the removal of the Section G items from OBRA assessments.

The MDS changes CMS planned for October 1, 2020 will now be delayed. CMS staff are actively engaged in discussions with various stakeholders, regarding the various changes, the impacts of these changes, as well as, the compressed timeline to educate and train facility staff and update software and IT systems.

Please direct any comments or questions regarding the above information to MDSCodinganswers@cms.hhs.gov mailbox.

SNF PDPM Claims Issue

CMS recently posted the following on their MLN Connects webpage, which can be found at www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-02-27#_Toc33530674.

Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) initial claims that are processed out of sequence are not paying the correct Variable Per Diem (VPD)-adjusted rate. Also, all adjustment claims are not processing correctly. Claims need to process in date of service order for each stay for the VPD to calculate correctly. We will correct this issue in October. In the interim:

  • Submit claims in sequence by waiting at least 2 weeks before billing subsequent claims;
  • To adjust claims, cancel the initial claim and all subsequent claims in the SNF stay then rebill in sequential order; or, hold adjustments (when allowable) until October when they will process correctly;
  • We encourage you to submit a complete bill at the time of entry.