SNF PPS final rule published, new payment model to begin October 1, 2019

It’s official: According to CMS’ Skilled Nursing Facility (SNF) Prospective Payment System (PPS) final rule published in the Federal Register yesterday evening, the Patient-Driven Payment Model (PDPM)—the new case-mix methodology to replace RUG-IV)—is effective October 1, 2018. Facilities will have a year to transition to PDPM from RUG-IV by the October 1, 2019 implementation date. […]

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. […]

TIP: What providers can be doing to prepare for RCS-1

The Summary of Advance Notice published back in April announcing potential options for revising certain aspects of the SNF PPS payment method places significant importance on clinical categories and resident characteristics documented within the MDS. This new model, RCS-1, would replace RUG-IV, if approved. This change is expected to happen by January 2019, pending public […]

Lawmakers estimate CMS mandate will cost providers $50,000 annually, letters submitted to delay provisions

More than 100 lawmakers signed a letter submitted by the House to CMS Administrator Seema Verma and new Department of Health and Human Services Acting Secretary Eric Hargan last week, urging the agency to delay costly provisions implemented in a final rule published in October 2016 updating Requirements of Participation (RoPs) for skilled nursing facilities/nursing […]

The essential role of MDS 3.0 in RCS-1

Written by Steven Littlehale, MS, GCNS-BC, executive vice president & chief clinical officer for PointRight. The full article originally appeared in the October issue of PPS Alert for Long-Term Care. The clinical and technical eligibility requirements for skilled care coverage in a SNF are unchanged under the proposed RCS-1 system—and frankly, those are just about […]

CMS corrects error in rejecting claims made to SNF CB on or after January 1, 2015

In an MLN Matters article published August 4, 2017, CMS announced that change request (CR) 10163¾which provides updates to the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the Consolidated Billing (CB) provision of the SNF Prospective Payment System (PPS)¾corrects an error impacting certain claims with dates of service on […]

Top three concerns of technical expert panel members for RCS-1 pre-rule

Today, a member of the Technical Expert Panel (TEP) involved in discussing CMS’ proposed case mix pre-rule shared with Post-Acute Advisor the top three concerns discussed among other TEP members and advocacy groups. Topics are as follows: #1. Protections to ensure beneficiary access to care. Providers and beneficiaries are seeking more clarifications into system safeguards […]

Mark next SNF/LTC Open Door Forum on your calendar

The next CMS SNF/LTC Open Door Forum (ODF) is scheduled for Thursday, June 22, 2:00pm – 3:00pm ET, to discuss the advanced notice of proposed rulemaking (ANPRM) published in April. The ANPRM solicits comments on potential options CMS may consider for revising certain aspects of the existing SNF PPS payment methodology to improve its accuracy, […]

CMS welcomes feedback on proposed case-mix rule, extends comment deadline

The Centers for Medicare & Medicaid Services (CMS) has extended the comment deadline for the advance notice of proposed revisions to case-mix methodology rule from June 26, 2017 to August 25, 2017. The advance notice of proposed rulemaking, titled “Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities: Revisions to Case-mix Methodology,” was published […]