On August 4th CMS published the SNF PPS Final Rule. Skilled nursing facilities should be preparing now for these upcoming changes. This Rule refresh:
- Updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for the fiscal year 2022
- Updates the diagnosis code mappings used under the Patient-Driven Payment Model (PDPM)
- Implements a recently-enacted SNF consolidated billing exclusion, and
- Includes a discussion of a PDPM parity adjustment that may occur in the future.
In addition, the final rule includes updates for the SNF Quality Reporting Program (QRP) and the SNF Value-Based Purchasing (VBP) Program, including a policy to suppress the use of the SNF readmission measure for scoring and payment adjustment purposes in the FY 2022 SNF VBP Program due to COVID-19.
How to prepare:
- Be sure the MDS Coordinator and billing are aware of the changes in the ICD-10 mapping and the new consolidated billing exclusions related to blood-clotting factors. Read our blog for more information on ICD-10 changes.
- Provide education to clinical staff on changes to VBP and QRP and verify you have processes in place to ensure that all required information is reported timely. See our summary for more information on QRP changes.
- Ensure the infection control nurse has a process in place to report required vaccine information to the CDC and is monitoring Healthcare-Associated Infections.
- Continue to monitor facility readmission rates and ensure a process is in place to reduce unnecessary rehospitalizations. The VBP may have been suppressed this year, but the program is currently collected data for future fiscal years. Get more information on VBP updates.
- Ensure the facility has proper documentation to support extensive services, isolation, and any nontherapy ancillaries (NTA) coded. The items are sure to be audited in the upcoming year due to the increase in coding these items.
- As always, continue to ensure compliance and accuracy of MDS coding and processes.
For additional information:
Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2022: https://www.federalregister.gov/documents/2021/08/04/2021-16309/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities