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As of June 15, 2018, PBJ Users will no longer be able to submit PBJ data for staffing dates prior to January 1, 2018. You will still be able to review PBJ data for staffing dates prior to January 1, 2018, using CASPER reports.
This change does not affect any of the deadline rules stated in the PBJ Policy Manual or online. The next reporting due date is August 14, 2018 for Reporting Period, April 1-June 30th.
The QIES Technical Support Office (QTSO) Help Desk is available for technical support and assistance related to PBJ questions, and may be contacted by phone at 800-339-9313 or by email to email@example.com.
Reducing Antipsychotic Medication Use
TMF's Nursing Home Quality Improvement program has posted on reducing antipsychotic medication use. Engaging residents in their care and providing treatment alternatives assists in reducing the unnecessary use of antipsychotics. Click on the following links to learn more about reducing the use of antipsychotic medications:
Final Check for SNF-QRP
May 15th is coming soon and it is an important date related to the submission deadline for the Skilled Nursing Facility Quality Reporting Program (SNF-QRP) requirements. Be sure you have submitted all MDS data for January-December (Q1-Q4) for CY 2017 by this deadline and that all assessments submitted are accurately completed and not dash-filled when not appropriate.
Three other reports that will be helpful include the SNF QRP Facility-Level and Resident-Level Quality Measure Reports and SNF Review and Correct Reports. These reports are located under the SNF Quality Reporting Program link in the Report Categories in CASPER. Contact us for assistance in accessing and/or interpreting these reports.
After the May 15th reporting deadline, all corrections or changes must be made prior to the quarter’s data submission deadline, which is 4.5 months after the end of the quarter. Correction periods for each quarter end as follows:
Q1 (1/1—3/31): August 15
Q2 (4/1—6/30): November 15
Q3 (7/1—9/30): February 15
Q4 (10/1-12/31): May 15
Have you accessed your PEPPER?
PEPPER is a Program for Evaluating Payment Patterns Electronic Report and summarizes Medicare claims data in areas that may be at risk for improper payments. PEPPER cannot identify improper Medicare payments, but summarizes information and identifies potential SNF Target Areas.
Providers are encouraged to access their PEPPER reports to identify potential problem areas; however, you are not required to use PEPPER. Be aware that the Medicare Administrative Contractor (MAC) is reporting the number of facilities who access their reports per state. The recently reported data reflects the PEPPER release completed April 9, 2018. You may access the SNF data per state by clicking this link: Map of Q4FY17 SNF PEPPER retrievals by state.
If you need help obtaining your report or have questions related to PEPPER, visit the PEPPER Help Desk to request assistance.
With this revision, CMS is discontinuing the five Skilled Nursing Facility (SNF) Denial Letters and the Notice of Exclusion from Medicare Benefits (NEMB-SNF), Form CMS-20014. Please note, the Notice of Medicare Non-Coverage (NOMNC), Form CMS-10123 is not being discontinued with this revised SNF ABN. SNFs will continue to use the Advance Beneficiary Notice of Non-coverage (ABN, Form CMS-R-131) for items or services that Medicare may be deny under Medicare Part B. SNFs may start using the updated Notice of Non-Coverage anytime, but as of April 30, 2018, the use of the new notice is mandatory.
Note: Further details are available at https://www.cms.gov/Medicare/Medicare-General-Information/BNI/FFS-SNFABN-.html. You may download the revised Form CMS-10055 in the Downloads section of that webpage. If you have any questions, please contact Novitas, your Medicare Administrative Contractor (MAC), at: 1-855-252-8782.
PBJ Important Update:
As of April, 2018, CMS will use PBJ data to determine each facility’s staffing measure on Nursing Home Compare and calculate the staffing rating used in the Nursing Home Five-Star Quality Rating System. Beginning June 1, 2018, nursing homes will no longer be required to complete the staffing portion of the CMS-671 form, however all other information listed on the form is still required.
Caution: Nursing homes reporting 7 or more days in a quarter with no RN hours, OR who fail to submit any data by the required deadline of May 15, 2018, will receive a one-star rating in the staffing domain, which will drop their overall (composite) star rating by one star for a quarter. This action will be implemented July 2018, after the May 15th submission deadline and applies to Quarter 1, 2018 (January – March, 2018) data.
As a reminder, each nursing home’s census is calculated using MDS data, and the census information is used to calculate the staffing measure. Therefore, it is critical that nursing homes adhere to the MDS completion and transmission requirements. This includes submitting discharge assessments timely, and completing required assessments for every resident within the certified facility.
CMS has identified some problem areas in reporting their staffing data on PBJ and are reminding nursing homes to exclude time for meal breaks whether paid or unpaid for all staff (exempt, nonexempt, and contract).
Nursing homes are strongly encouraged to run CASPER reports (1700D Employee Report, 1702D Individual Daily Staffing Report, and/or 1702S Staffing Summary Report) prior to their submission, and before the quarterly deadline, to review their data and ensure accuracy. Also, homes should continue to review their monthly Provider Preview reports located in CASPER for feedback on their most recent submission.
The PBJ website, Policy Manual, and Frequently Asked Questions are available HERE.
Five-Star Rating Calculations
Background: To calculate a nursing home’s Five Star Rating on Nursing Home Compare, there are 3 Domains that are used: Health Inspection, Quality Measures, and Staffing. Each of these domains receive a star rating. Then, using a specified formula, the Overall Star Rating is calculated from these 3 domains. The formula starts with the Health Inspection Domain and an Overall Rating cannot be calculated without it.
CMS will be holding constant, or “freezing,” the Health Inspection Star Rating for health inspection surveys and complaint investigations conducted on or after November 28, 2017. This “freeze” will occur in early 2018. At that time, facilities’ Health Inspection Domain Star Rating will be calculated using the two most recent standard surveys that occurred prior to November 28, 2017, and any citations from complaint surveys that occurred between 11/28/2015 and 11/27/2017. The Health Inspection Ratings will then be combined with the Staffing and Quality Measure Domain Ratings, as they normally would be, and the Overall Star Rating will continue to reflect the Health Inspection, Staffing, and Quality Measure Ratings.
Click here for an overview of Oklahoma nursing home performance with comparative data from region and nation for select long-stay quality measures for the period ending March 31, 2017. Note: Statistical significance was determined based on the 95% confidence interval. Email QIEShelpdesk@health.ok.gov for more information.
For questions related to software or technical requirements, please email NursingHomePBJTechIssues@cms.hhs.gov.
For questions related to PBJ policies, please email NHstaffing@cms.hhs.gov.
Nursing Facilities have two options available for obtaining software specific to the transmission of MDS assessment data:
Facilities may obtain software developed by private vendors, but need to ensure the software meets the minimum specifications established by CMS.
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JRAVEN / RAVEN Software for Long Term Care Providers:
Dialer Software (Juniper Client/Verizon):