PDPM
What’s up with the Five-Star Quality Rating System
What’s up with the Five-Star and Care Compare? The Nursing Home Compare Five-Star Quality Rating System was developed by the Centers for Medicare & Medicaid Services (CMS) to assist residents and their families with information to “understand assessment of nursing home quality.” The domains of the Five-Star Quality Rating System are State Health Inspections…
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Prepare Your Team for FY2022
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…
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ICD-10 Coding and Guideline Updates for FY 2022
Earlier this summer, the Centers for Medicare & Medicaid Services (CMS) released the ICD-10-CM code descriptions, tables and index, and addendum for the fiscal year 2022. Then on July 12th, the Official Guidelines for Coding and Reporting of ICD-10-CM became available online. The updated manual and guidelines for FY 2022 revealed 159 new codes, along…
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Can I interrupt? Understanding the Interrupted Stay Policy
During a Medicare part A stay, a resident goes to the hospital. He returns to the facility after 72 hours. Is this an interrupted stay? Deciding if a resident qualifies for an interrupted stay or requires a new assessment may be difficult at times. The key to the interrupted stay is the “3-midnight rule.” According…
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Is the Value Based Purchasing Program Changing?
The Centers for Medicare & Medicaid Services (CMS) issued its fiscal year (FY) 2022 proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) in April. In addition to announcing a 1.3% payment update for FY 2022, the rule proposes multiple changes to the Value-Based Payment (VBP) program. CMS believes that scores on…
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SNF QRP Changes are Coming
The Proposed Rule for Fiscal Year (FY) 2022 for the Skilled Nursing Facility Prospective Payment System was released early April 2021. Now that providers have had a chance to digest the proposed SNF payment updates and the PDPM parity adjustment, attention turns to the quality initiatives that have been updated. The Quality Reporting Program has…
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The Struggle with Antipsychotic Reduction
Since CMS began to monitor antipsychotic use in 2011, skilled nursing facilities have done well to reduce the use of antipsychotic medications from the original rate of 23.9%. However, over the past few years, the rate has remained around 14%. Some facilities believe they have done everything possible and this 14% represents residents that truly…
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Non-Therapy Ancillaries: What are you missing?
The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. (difference of NE-NF and NA-NB). The general method for calculation of any NTA category is as follows: Points (1-8) are assigned…
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Five-Star Preview: Not All Good News
The transition from Nursing Home Compare to Care Compare and unexpected Five Star Quality Rating updates brought disappointment to some Skilled Nursing Facilities. Due to the public health emergency (PHE), the rating system’s three domains had previously been held constant. Centers for Medicare and Medicaid Services (CMS) announced that the Five Star Quality Rating system…
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Focused Infection Control Surveys and Directed Plan of Correction
It’s a dreary Monday morning, and the state surveyors walk into your facility to conduct a Focused Infection Control survey. You and your team have been trying your hardest to comply with infection control procedures throughout the pandemic. At the end of the survey, you are issued several citations and the state is requiring the…
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