Nursing Home Compare Quarterly Refresh with SNF QRP Data Now Available

Nursing Home Compare Quarterly Refresh with
SNF QRP Data Now Available

Background

CMS announced that the January 2019 Nursing Home Compare Refresh, including quality measures results based on SNF Quality Reporting Program (QRP) data submitted to CMS as required by the IMPACT Act, is now available.

What you need to know

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

  1. Quarter 2 – 2017 to Quarter 1 – 2018 data
  • Application of Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay)
  • Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short Stay)
  • Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function
  1. Quarter 4 – 2016 to Quarter 3 – 2017 data
  • Medicare Spending Per Beneficiary – Post-Acute Care (PAC) Skilled Nursing Facility Measure
  • Discharge to Community – Post-Acute Care (PAC) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)

As a reminder, CMS announced in October 2018 that it will not publish the 6th previously posted quality measure, Potentially Preventable 30-Day Post-Discharge Readmissions, at this time.

According to CMS, additional time will allow for more testing to determine if modifications to the measure and method of displaying it are needed. This additional testing will ensure that the future publicly reported measure is thoroughly evaluated so Nursing Home Compare users have an accurate picture of provider quality. While CMS conducts this additional testing, the agency will not post reportable data for this measure, including each SNF’s performance, as well as the national rate. To view the updated quality data, please visit the Nursing Home Compare website.

Courtesy of NASL

If you have any questions, please contact:
Maria Maggi, Vice President of Compliance
mmaggi@preftherapy.com

*TIME SENSITIVE* SNF Provider Preview Reports Now Available

*TIME SENSITIVE*SNF Provider Preview Reports Now AvailableREVIEW BEFORE DATA MADE PUBLIC

Background

Prior to the release of SNF QRP data on Nursing Home Compare, SNFs have the opportunity to review their quality measure results during a 30-day preview period. Providers have until March 4, 2019, to review QRP data prior to the April 2019 Nursing Home Compare site refresh, during which this data will be publicly displayed. SNFs are encouraged to review the SNF Provider Preview Report, issued quarterly by CMS and accessed through the CASPER system. Instructions on how to access these reports are located here.

Corrections to the underlying data will not be permitted during this time, however, providers can request a CMS review of their data during the preview period if they believe the quality measure scores that are displayed within their Preview Reports are inaccurate.

What you need to know

The data contained within the Preview Reports is based on quality data submitted by SNFs during the following quarterly time frames:

  • Quarter 3 – 2017 to Quarter 2 – 2018 data
    • Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay)
    • Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short Stay)
    • Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function
  • Quarter 4 – 2016 to Quarter 3 – 2017 data 
    • Medicare Spending Per Beneficiary – Post-Acute Care (PAC) Skilled Nursing Facility Measure
    • Discharge to Community- Post Acute Care (PAC) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)

As we stated in our last alert, CMS announced in October 2018 that it will not publish the 6th previously posted quality measure, Potentially Preventable 30-Day Post-Discharge Readmissions, at this time. According to CMS, additional time will allow for more testing to determine if modifications to the measure and method of displaying it are needed. This additional testing will ensure that the future publicly reported measure is thoroughly evaluated so Nursing Home Compare users have an accurate picture of provider quality. While CMS conducts this additional testing, the agency will not post reportable data for this measure, including each SNF’s performance, as well as the national rate. To view the updated quality data, please visit the Nursing Home Compare website.

Courtesy of NASL

If you have any questions, please contact Maria Maggi, Vice President of Compliance mmaggi@preftherapy.com.

yourSource | Newsletter 2019 State of the Union with Liz Almeida-Sanborn

An Interdisciplinary Approach to Alphabet Soup

PDPM/QRP/ VBP – an introduction

With the effective date of the Patient Driven Payment Model (PDPM) finalized, and SNF QRP and VBP in place, 2019 is shaping up to be a blockbuster year for the Long-Term Care Industry. By now, many of us are knee deep in preparing for the changes associated with the shift from volume to value. With so much riding on our comprehension of these major fundamental reporting and reimbursement changes, a prepared and well-versed interdisciplinary team is critical to the success of post-acute care providers. Members of the interdisciplinary team, especially clinical leadership, must have an in-depth understanding of how facilities are being (and will be) evaluated and reimbursed and what can be implemented now to safeguard future success. PDPM is the most significant change to SNF reimbursement since, well, the last most significant change to SNF reimbursement; RUGs. The reality is that these changes are intended to be budget neutral across the industry. Practically speaking, that means some facilities will thrive and others may struggle, impacted by reimbursement reductions. READ MORE

Billing Reminder! CMS 2019 Physician Fee Schedule Final Rule Is Now In Effect!

Physician Fee Schedule Effective January 1, 2019

Background

CMS released the Physician Fee Schedule Final Rule in November 2018 with an effective date of January 1, 2019.

What you need to know

Functional Limitations (G Coding)As of January 1st, entering of G codes on Medicare B claims is no longer required. However, we have instructed our rehab teams to continue to enter them for any Managed Care provider that requires them unless notified otherwise.

KX Modifier / Threshold

Although CMS repealed the therapy cap in 2018, CMS continues to require a KX modifier be applied to services over the threshold amounts, which for 2019 are as follows: $2040 for PT and ST combined, and $2040 for OT. Our billing exports will continue to include the KX modifier.

Rate Increase

The fee schedule rates were increased by .11% in aggregate; reimbursement for some codes increased, some decreased. Please verify that your software has been updated accordingly.

New Assistant Modifiers

CMS created new modifiers to be entered on claims for Med B beginning Jan, 2020: CQ (for services performed by a Physical Therapy Assistant) and CO (for services performed by an Occupational Therapy Assistant). These modifiers distinguish rehab services that were performed by an assistant versus a registered therapist. This is NOT required at this time. CMS will notify us when the voluntary use of the codes will begin. In the meantime, rest assured that our software will provide the appropriate coding and come through on our billing export.

If you have any questions, please contact: Maria Maggi, Vice President of Compliance at mmaggi@preftherapy.com.

Matt Nash, Vice President of Strategic Development Discusses The Future of SNF Medicare Reimbursement: Patient-Driven Payment Model

Matt Nash, Vice President of Strategic Development discusses The Future of SNF Medicare Reimbursement: Patient-Driven Payment Model at the Maine Health Care Association Fall Health Care Conference & Expo. Matt provides expert knowledge and thorough understanding of the complexities associated with the Patient Driven Payment Model leading to SNF reimbursement success.

SNF QRP Submission Deadline Approaching

Background

The Skilled Nursing Facility Quality Reporting Program (SNF QRP) requires facilities to report assessment data in a timely manner. Providers must submit all data necessary to calculate the SNF QRP measures on at least 80% of the MDS assessments to be in compliance and avoid a 2% reduction to their Annual Payment Update (APU).

What you need to know

MDS data for Quarter 2 of CY 2018 (4/1/18-6/30/18) must be submitted no later than 11:59 p.m. PST on November 15, 2018.

Providers are encouraged to run validation and analysis reports prior to each quarterly reporting deadline to insure all required data has been submitted.

CMS, via subcontractor CORMAC, notifies SNF’s prior to the submission deadline if the facility is not meeting APU threshold via email. If you need to add or change the email address to which these messages are sent, email QRPHelp@cormac-corp.com.

The list of measures required for this deadline can be found on the CMS QRP website:

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

New York MDS Case Mix Picture Date Update

Yesterday, September 17, 2018 the NY DOH held a monthly briefing and announced they will release final details today with regard to the NY MDS case mix picture updates which will be utilized for the upcoming CMI adjustment to the 1/1/19 rates. The DOH announced two collection dates.

  •  April 25, 2018.   (January 23rd look back) 
  •  July 25, 2018.    (April 24th look back)

DOH will then analyze and blend the two collection period results prior to uploading the MDS data in early October. DOH continues to review historical MDS data prior to convening the Case Mix Workgroup, which will be established to discuss CMI streamlining per the Executive Budget. A start date for the Workgroup has not yet been announced.

Courtesy of NYSHFA

If you have any questions, please contact Jodi Wenzel, Senior Vice President of Operations: jwenzel@preftherapy.com

CMS Releases FY 2019 SNF PPS Final Rule: PDPM Finalized

CMS Releases FY 2019 SNF PPS Final Rule: PDPM Finalized

Background

Late yesterday afternoon, the Centers for Medicare and Medicaid (CMS) released the Final Rule for FY 2019 SNF Prospective Payment System (SNF PPS), SNF Value-Based Purchasing Program (SNF VBP) and the SNF Quality Reporting Program (SNF QRP). Of significant importance, the Patient-Driven Payment Model was finalized with an implementation date of October 1, 2019.

What You Need To Know

SNF PPS Payment Update

  • Finalized the market basket increase of 2.4%, which results in an estimated increase of $820 million in aggregate payments to SNFs during FY 2019

Patient-Driven Payment Model (PDPM)

  • PDPM will replace the current RUG IV payment model effective October 1, 2019
  • CMS adopted many of the proposed changes under PDPM from the Proposed Rule without modifications, including the following:
    • Case-mix classification for the ST component, Nursing component, and NTA component
    • Variable Per Diem payment adjustments for PT/OT and NTA
    • Revisions to the MDS completion schedule were finalized to include only the 5-day PPS assessment and PPS discharge assessment as required. In addition, new items to report therapy start/end date and therapy minutes on the discharge assessment were finalized
    • Group and Concurrent therapy limits set at a combined 25% of therapy minutes per discipline
    • Interrupted stay policy
  • CMS adopted other proposed changes under PDPM from the Proposed Rule with modifications or clarifications, including the following:
    • Clinical category classification for PT and OT component would be based on ICD-10-CM coding on Section I8000 as well as the use of a sub-item within Item J2000, which would identify relevant surgical procedures
      • In effect, this allows providers the opportunity to report 2 diagnoses’ to most accurately capture clinical complexities for PT and OT CMI.
    • Section GG was finalized as the source to calculate functional scores with modifications to incorporate new responses and items that are set to become effective 10/1/2018 based on the SNF QRP
    • The new Interim Payment Assessment (IPA) would be an optional assessment rather than required
    • SNF Level of Care Criteria (presumption of coverage) was modified to include an additional 6 PT/OT classifiers and 8 SLP classifiers

SNF QRP

  • While there are no new quality measures or changes to reporting requirements contained in this final rule, there are additional quality measures set to become effective for FY 2019 and FY 2020 based on prior rulemaking
  • An additional quality measure removal factor “costs associated with measure outweigh the benefit of continued use in the program” was added to the other 7 removal factors

SNF VBP

  • The overall economic impact to SNFs based on this program for FY 2019 is a reduction of $211 million in aggregate payments
  • FY 2021 baseline and performance periods were finalized
    • Baseline period is FY 2017 and performance standards (i.e. achievement threshold and benchmarks) have been established
    • Performance period is FY 2019 (October 2018 through September 2019)

PTS is currently reviewing the FY 2019 Final Rule and will be providing education/training to our staff and valued partners. We are looking forward to working collaboratively with our partners for a successful transition to PDPM.

While PDPM is certainly the most significant area addressed in the Final Rule, it is important to not lose focus on both the SNF QRP and SNF VBP. Both of these programs pose financial risk to providers as well as shape public perceptions of the quality of care provided at our SNFs based on public reporting of quality measures and rehospitalizations.

If you have any questions, please contact Matt Nash, Vice President of Strategic Development: mnash@preftherapy.com

Skilled Nursing Facility (SNF) Provider Preview

Skilled Nursing Facility (SNF) Provider Preview Reports have been updated and are now available. Providers have until June 30, 2018 to review their performance data prior to public display on the Nursing Home Compare site. Corrections to the underlying data will not be permitted during this time. However, providers can request a CMS review during the preview period if they believe their data scores displayed are inaccurate.The SNF Provider Preview Report includes performance data on the following quality measures based on the subsequent Quarterly data:

Quarter 1 – 2017 to Quarter 4 – 2017 data

  1. Application of Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay) (#0674).
  2. Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (Short Stay) (NQF #0678).
  3. Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (#2631).

 Quarter 4 – 2016 to Quarter 3 – 2017 data 

  1. Medicare Spending Per Beneficiary – Post-Acute Care (PAC) Skilled Nursing Facility Measure.
  2. Discharge to Community- Post Acute Care (PAC) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP).

Quarter 4 – 2015 to Quarter 3 – 2017 data

Potentially Preventable 30-Days Post-Discharge Readmission Measure for Skilled Nursing Facility (SNF) Quality Reporting Program (QRP).

Courtesy of NASL

If you have any questions, please contact Matt Nash, Vice President of Strategic Development: mnash@preftherapy.com