Tag: PPS

SNF QRP reconsideration deadline on August 15

Per the Skilled Nursing Facility Prospective Payment System Final Rule (80 FR), any SNF found to be non-compliant with QRP requirements is subject to a 2%-point reduction in their annual payment update (APU). SNFs found to be non-compliant have received a letter from CMS that includes instructions for reconsideration requests. Requests will only be considered within […]

CMS issues new SNF PPS Final Rule for 2020

On July 30 CMS issued a final rule updating the payment rates under the prospective payment system (PPS) for SNFs. The rule, designed to increase aggregate payments to SNFs by $851 million in 2020 compared to 2019, will go into effect on October 1. This rule includes three main revisions: The rule includes minor changes […]

CMS seeking feedback on potential future quality measures and assessment data

A significant portion of the 2020 PPS proposed rule deals with potential measures and associated assessment elements that could come to the home health industry in the future. While CMS is not planning to finalize any of these measures or standardized patient assessment data elements (SPADES) as part of the rulemaking process this year, CMS […]

LUPAs remain a complicated area under PDGM

Source: Home Health Line Despite the fact that payment episodes under the Patient-Driven Groupings Model (PDGM) will last 30 days instead of 60, LUPAs still will occur under the new payment model CMS is creating beginning on or after Jan. 1, 2020. Unlike with the PPS, where a LUPA involves four or fewer visits during […]

RCS-1 draft model calculation worksheet

SNF providers are on the edge of their seats as they anticipate CMS’ consideration of a replacement for the Resource Utilization Group (RUG) system, which will change the way facilities are reimbursed for SNF Medicare Part A residents beginning as early as FY2019. The Resident Classification System, Version 1 (RCS-1) will be the most significant […]

Who needs to prepare for RCS-1?

On July 31, 2016, CMS announced that the payment levels currently used in the prospective payment system (PPS), resource utilization group (RUG) IV, will be replaced in FY2019 by the resident classification system (RCS-1). This replacement is currently scheduled to be implemented by October 2018. This will be a complicated and significant change for providers. […]

CMS decides not to move forward with Home Health Groupings Model in 2019

The following is an excerpt from Home Health Line. Agencies can breathe a deep sigh of relief. CMS won’t launch its drastically revised home health payment model after all. In the 2018 final PPS rule released Nov. 1, CMS announced that it would not launch the Home Health Groupings Model (HHGM) in 2019. “We are […]

MedPAC sends recommendations for SNF pay cuts and revised PPS to Congress

In the Medicare Payment Advisory Commission’s (MedPAC) final meeting of 2016, the advisory panel considered two key questions: Are Medicare payments for skilled nursing facility (SNF) care adequate? How should Medicare’s payments change for fiscal year 2018? On Thursday, January 12, the advisory panel submitted their recommended answers to Congress, which suggested the elimination of […]

Medicare could have saved billions if swing-beds were paid at SNF rates

According to a recent report to Congress, OIG estimates that Medicare could have saved billions at critical access hospitals (CAH) if swing-bed services were reimbursed using the skilled nursing facility prospective payment system rates. For this report, OIG reviewed swing-bed Medicare claims data at CAHs and claims data at alternative facilities providing care at the […]