SNF Provider Preview Reports are available during a 30-calendar day preview period beginning from the date on which providers can access the report. SNF providers have until May 30, 2019 to review reports that contain data submitted between 2017 Quarter 4 and 2018 Quarter 3 for assessment-based quality measures, and between 2017 Quarter 1 to 2017 Quarter 4 for claims-based quality measures.
Staffing data from Jan 1 through March 31 must be submitted no later than 45 days from the end of the quarter. The final submission deadline for this quarter is May 15, 2019. On a SNF open door forum held earlier this week, officials instructed facilities to review their monthly provider preview reports in their CASPER folder for feedback on their most recent submission.
Once you come to understand how reimbursement will be calculated under the new skilled nursing facility (SNF) prospective payment system (PPS) model, Patient Driven Payment Model (PDPM), you may wonder why it wasn’t named the Primary Diagnosis Driven Payment Model, but that’s a conversation for another day. What we should be focusing on is the fact that under PDPM, each resident’s primary diagnosis code entered into line I0020B of the minimum data set (MDS) (a new MDS field that will be added effective 10/1/2019) will be used to place the patient into one of ten PDPM clinical categories. These clinical categories are then used as part of the patient’s classification under the physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) components. A resident’s primary diagnosis code is essentially the hinge for that resident’s clinical documentation and reimbursement path, so getting it right is essential in order to achieve accurate reimbursement under PDPM.
A list of facilities with potential staffing issues is being provided to CMS regional offices and state survey agencies to support survey activities for evaluating sufficient staffing, according to a memo released by CMS back in November, 2018. The memo states that “while CMS is encouraged by facilities’ efforts to improve staffing,” payroll based journal (PBJ) data has raised a few concerns, prompting them to inform state survey agencies of facilities with potential staffing issues. These issues include facilities with significantly low nurse staffing levels on weekends and facilities with several days in a quarter without an RN onsite.
The purpose of the MDS chart audit tool is to ensure documentation is present in the medical record to support the findings of the MDS. Use the tool at the end of the month or the episode of care. If documentation that supports the MDS is present for each item, place a checkmark. If it is not, highlight the area so it can be followed up on to ensure completeness. This form can be completed by the MDS coordinator, DON, medical records, therapy director, or delegated per area of specialty. Download this Billers’ Association for LTC member resource.
SNFs must provide quality care to residents in a field that is being suffocated by regulation and paperwork, and that is placing ever-increasing importance on data. The key is to ensure the data does not eclipse the care. SNFs must adhere to the principle that putting residents first will improve quality measures, increase reimbursement rates, and ensure a successful survey. Enhancing resident care will then give a facility the reputational excellence it needs to fill its beds.
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.
Q: What should we do if we feel that the auditor’s findings are blatantly wrong?
A: If it is felt the auditor was blatantly wrong, providers should contact the agency immediately to discuss it. For instance, if there was a prescription, but it wasn’t in the file that the auditor had, then it would not be considered an error on the auditor’s part, and the facility should follow the appropriate appeals process. But if the auditor made a mistake, he or she should correct it accordingly before proceeding with an overpayment. If the auditor won’t fix the error, then ask to speak with his or her superior about the issue. Providers have the right to accurate decision-making when it comes to claims processing, medical review, and audits.