• FY 2009: Prospective Payment System and Consolidated Billing For SNFs; Proposed Rule (73 FR 25918), is available for download from the "List of SNF Federal Regulations" page.
  
• FY 2009 Proposed Rule Case Mix Indices (CMIs) Recalibration
  • The recalibrated CMIs were calculated based on the Calendar Year (CY) 2006 RUG distribution available in the downloads section below (SNF FY 2009 NPRM CMI Calculation).
  • CMS used the following information to calculate the percentage adjustment necessary to recalibrate nursing CMIs: the CY 2006 RUG distribution in the downloads section below (SNF FY 2009 NPRM RUG Distribution), the FY 2008 unadjusted federal per diem payment rate components (72 FR 43416), and the RUG-53 unadjusted CMIs located on the "RUG Refinements" page.
  • The final adjusted CMIs are available in the downloads section (SNF FY 2009 NPRM CMI Calculation).
    
• Minimum Data Set, Version 3 (MDS 3.0) and STRIVE--On January 15, 2008, CMS released the revised proposed version of the (MDS 3.0), including the form and instructions. Additional details can be found on the Time Study (STRIVE) webpage.
  
  
• FY 2008: Prospective Payment System and Consolidated Billing For SNFs; Corrections (72 FR 67652), effective January 1, 2008, is available for download from the "List of SNF Federal Regulations" page.  This notice affects only two particular core-based statistical areas (CBSAs): CBSA 16180 (Carson City, NV) and CBSA 39900 (Reno-Sparks, NV). SNFs should contact their fiscal intermediaries with any billing questions.
  

• Billing Information for SNFs is available in chart form for download from the "Education & Training" page.
  
  
•  FY 2008: Prospective Payment System and Consolidated Billing for SNFs; Corrections (72 FR 55085) is available for download from the "List of SNF Federal Regulations" page.  The following two primary issues are addressed in the correction notice:
  
  • Labor-Related Share: We have identified a technical error in the construction of the SNF market basket update. This error did not affect the final market basket update factor of 3.3 percent, but did affect the labor-related share. The corrected labor-related share is 70.249.
    
  • Wage Index: We have determined that in the process of developing the most recent hospital wage index, two inpatient hospital providers with wage data that belonged in the Hartford-West Hartford-East Hartford, CT core-based statistical area (CBSA) were inadvertently included in rural Connecticut instead. We are revising the wage index value for CBSA Code 25540 (Hartford-West Hartford-East Hartford, CT) from 1.0937 to the corrected value of 1.0930. Similarly, we are revising the wage index value for CBSA Code 7 (rural Connecticut) from 1.1283 to the corrected value of 1.1711.
    
    
• Labor-related Share and Market Basket Comparisons
  1. Labor-related Share Comparison (Update_LRS_SNF_BL.xls): This file contains a comparison of labor-related shares between the FY 2007 Final Rule, FY 2008 NPRM, and the FY 2008 Correction Notice for SNF PPS. It also includes the methodology used in calculating the labor-related share.
     
  2. Market Basket Comparison (MB Compare FY2008_BL.xls): This file contains the calculation methodology and a comparison of the market basket published in the FY 2008 NPRM and the FY 2008 Correction Notice. The price proxy percent changes used to determine the FY 2008 NPRM and FY 2008 Correction Notice market baskets are included.
     
     
• FY 2008: Prospective Payment System and Consolidated Billing for SNFs; Final Rule (72 FR 43412) is available for download from the "List of SNF Federal Regulations" page.
  
  
• FY 2008: Prospective Payment System and Consolidated Billing for SNFs; Proposed Rule is available for download from the "List of SNF Federal Regulations" page.
  
  
• STRIVE Time Study - Work on Staff Time and Resource Intensity Verification (STRIVE), a national nursing home time study, has begun. The STRIVE team conducted two pilots this spring. The first pilot took place in March in Annapolis, Maryland at the Spa Creek Center, and the second pilot took place in June in Madrid, Iowa at the Madrid Home for the Aging. The studies yielded useful information, and we would like to thank the staffs of both Spa Creek Center and the Madrid Home for the Aging for their excellent cooperation.
  
  In June 2006 our contractor Iowa Foundation for Medical Care (IFMC) began conducting the study in Iowa. The study took place in a total of fifteen states including Florida and Washington, D.C. We thank Illinois, Kentucky, Louisiana, Michigan, Montana, Nevada, New York, Ohio, South Dakota, Virginia, and Washington for sponsoring the studies in their states. Additional thanks go out to the Texas Medical Foundation (TMF), the Quality Improvement Organization (QIO) in Texas, which headed up the studies in that state. Thank you to participating nursing homes and provider associations for their participation and support of the project. On-site data collection ended in August 2007 and we are beginning the analytic phase of the project.
  
  
• Web Based Training on SNF Consolidated Billing is available on our CMS website. The training course covers general information about SNFs, consolidated billing, excluded services, consolidated billing during a noncovered stay, and "under arrangement" agreements. After taking the course, you should be able to identify SNF coverage guidelines, understand why Congress enacted consolidated billing, describe consolidated billing, recognize situations in which SNF consolidated billing requirements do not apply, identify services excluded from consolidated billing, identify services included under consolidated billing for beneficiaries in a noncovered stay, and understand the need for "under arrangement" agreements between SNFs and other providers or suppliers. You can link to this Web Based Training course below at Related Links Inside CMS.
  
  
• A SNF Prospective Payment System (PPS) fact sheet is available on our CMS website. The SNF PPS fact sheet covers rates and consolidated billing. You can link to the fact sheet below under Related Links Inside CMS.
  
  Print copies can be ordered from the Medicare Learning Network Product Ordering Page found below under Related Links Inside CMS. On the MLN Product Ordering Page, scroll down to Medicare Payment Policy. The title of the fact sheet is Skilled Nursing Facility Prospective Payment System, and the order number is ICN# 6821.
  
  
• FY 2007: Prospective Payment System and Consolidated Billing for SNFs; Correction Notice (71 FR 57519) is available for download from the "List of SNF Federal Regulations" page.
  
  
• FY 2007 Skilled Nursing Facility PPS Update Notice (71 FR 43158) published July 31, 2006
  
  
• Notice Regarding Provider Revalidation and the NPI
  We would like to clarify an issue which arose at the June 6, 2006 Skilled Nursing Facility-Long Term Care Open Door Forum. We contacted the Division of Provider/Supplier Enrollment. The revalidation process has not yet started, and Fiscal Intermediaries will contact facilities to notify them when the validation paperwork is required.
  
  Please note, however, that effective June 5, 2006, new facilities or facilities that need to update/change enrollment information are required to use the new 855 form. The National Provider Identifier (NPI) number is required on this form. Facilities that are not making changes do NOT have to complete a new 855.
  
  
• Swing Bed Manual Changes - Revised November 2005
  
  
• RUG-53 Education Material - RUG-53 will be implemented with dates of service beginning January 1, 2006. Information on the new nine groups is included in the following zip file. The Crosswalk document shows the services, conditions, and requirements that apply for each of the 53 RUG groups. The SNF PPS Refinement documents discuss the 9 new groups, software updates, payment implications, and other areas related to RUG-53. There are two versions of the SNF PPS Refinement; one for Skilled Nursing Facilities and the other for Hospital Swing Beds. The Crosswalk and the SNF PPS Refinement files should be used together for training and educational purposes. The documents were not created to be stand-alone material.
  
  
• Physicians Should Submit Professional Service Codes
  The professional services codes listed below were previously denied in error as improperly subject to consolidated billing. Skilled nursing facilities are not responsible for these codes when billed for the physician services listed below.
  
  CWF has been corrected to properly process the codes listed below beginning with claims submitted on October 13, 2005. Carriers have been instructed to automatically adjust any claims that were previously denied incorrectly no later than December 31, 2005. If any providers are currently holding these claims, they should now submit them.
  

29065, 29075, 29085, 29086, 29105, 29125, 29126, 29130, 29131, 29200, 29220, 29240, 29260, 29280, 29345, 29365, 29405, 29445, 29505, 29515, 29520, 29540, 29550, 29580, 29590

Downloads SNF FY 2009 NPRM RUG Distribution [ZIP, 8KB] SNF FY 2009 NPRM CMI Calculation [ZIP, 5KB] Labor-related Share and Market Basket Comparisons [ZIP, 17KB] Swing Bed Manual - Revised November 2005 [PDF, 1.38MB] List of Changes to the Swing Bed Manual - Revised November 2005 [PDF, 23.2Kb] RUG-53 Education Material [ZIP, 43kb] Related Links Inside CMS FY 2007 SNF PPS Update Notice (71 FR 43158) MLN Product Ordering Page SNF PPS Fact Sheet Web Based Training Including SNF Consolidated Billing Related Links Outside CMS Time Study (STRIVE) Website

Page Last Modified: 05/07/2008 2:41:18 PM
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