Spotlight

• Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group-Version 4 (RUG-IV)
  National Provider Call with Question & Answer Sessions scheduled for Wednesday, September 1, 2010
  
  The Centers for Medicare & Medicaid Services' (CMS) Provider Communications Group will host a national provider conference call on the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group-Version 4 (RUG-IV). This toll-free call will take place from 1:00 p.m. – 2:30 p.m., EDT, on Wednesday, September 1, 2010.

  This call is one in a series of calls designed to provide information on key aspects of the RUG-IV SNF PPS case mix system which will be put into place on an interim basis effective October 1, 2010. The first call, on June 23rd, discussed coding procedures with emphasis on the appropriate Look-back Period to be used when coding the Minimum Data Set MDS 3.0 and how facility staff should separately report individual, concurrent, and group therapy for accurate payment, along with changes to the ADL coding requirements and their impact on the assignment of MDS 3.0 records to a RUG-IV group. A PowerPoint slide presentation, MP3 audio file, and transcript are available for download from the Downloads and Related Links Inside CMS section below.  Two documents are provided for reference during the audio-conference, Short Stay Algorithm and RUG-IV SNF PPS Case Mix Indices, in addition to the power point presentation. Both are available in the Downloads section.

  CMS held a second call on August 24 where subject matter experts discussed the transition from RUG-III to RUG-IV. The PowerPoint slide presentation and RUG-III to RUG-IV transition spreadsheet are available for download from the Downloads and Related Links Inside CMS section below. In addition, an MP3 audio file and transcript of the call will also be made available for download from the Downloads and Related Links Inside CMS section below.
  
  As a continuation of the series, CMS will hold a call on Wednesday, September 1, 2010 to discuss Start of Therapy and End of Therapy Other Medicare Required Assessments and the SNF short stay policy. Following the formal presentation, callers will have an opportunity to ask questions of CMS subject matter experts.
  
  Conference call details:
  
  Date: September 1, 2010
  
  Conference Title: Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Resource Utilization Group – Version 4 (Rug-IV) National Provider Call
  
  Time: 1:00 p.m. EDT
  
  In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation.

  Registration will close at 1:00 p.m. EDT on August 31, 2010, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.
  
  1. To register for the call participants need to click on the National Provider Call link in the Related Links Outside CMS section below.
  2. Fill in all required data.
  3. Verify that your time zone is displayed correctly in the drop down box.
  4. Click "Register".
  5. You will be taken to the "Thank you for registering" page and will receive a confirmation email shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation emails. If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.
  6. If assistance for hearing impaired services is needed the request must be sent to medicare.ttt@palmettogba.com no later than 3 business day before the event.

  For those of who will be unable to attend, a transcript and MP3 audio file of the call will be available at least one week after the call.

• Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2011 (CMS-1338-NC) is available for download from the List of SNF Federal Regulations web page.
  • An electronic workable copy of the wage index tables is available for download from the Wage Index web page.
    • Technical Correction – The wage index value 0.8858 in Tables 8A and 8B, which is included in demonstrating the computation of adjusted PPS rates and SNF payment, should be changed to 0.8844 (see Table A: FY 2011 Wage Index for Urban Areas Based on CBSA Labor Market Areas). A correction notice is forthcoming.
• Explanation of FY 2011 Forecast Error Adjustment is available for download from the Downloads section below.
• Distribution of RUG Days Used to Calculate FY 2011 Rates for HR-III and RUG-IV is available for download from the Downloads section below.
• Payments Under the Skilled Nursing Facility Prospective Payment System (SNF PPS) For Fiscal Year (FY) 2011 - Update, May 24, 2010--Section 10325 of the Patient Protection and Affordable Care Act (ACA) includes a provision addressing Medicare payments for SNFs in FY 2011. This section mandates a delay in the introduction of the Resource Utilization Groups, version 4 (RUG-IV) case mix classification system until FY 2012. In addition, it requires that version 3.0 of the Minimum data Set (MDS 3.0) Resident Assessment Instrument will be implemented as planned in FY 2011. Finally, the section requires that certain specific components of RUG-IV, specifically, the concurrent therapy and look-back revisions, be applied in FY 2011. While there is currently an existing grouper (the software program that uses assessment data to assign each SNF resident to the appropriate RUG) that utilizes the 53-group RUG-III system and the MDS 2.0, and a revised grouper that utilizes RUG IV and the MDS 3.0, a grouper that incorporates the particular combination of features mandated by the statute does not currently exist.
  
  Accordingly, as we continue to build the payment infrastructure needed to incorporate the combination of features mandated by ACA, we will apply interim payment rates, effective October 1, 2010, that reflect not only the use of MDS 3.0 but also the new RUG-IV system in its entirety as finalized in the FY 2010 SNF PPS final rule (74 FR 40288, August 11, 2009). Once the necessary infrastructure is in place, we will then retroactively adjust the rates to reflect a hybrid RUG-III (HR-III) system which incorporates RUG-IV's specific revisions on concurrent therapy and the look-back period within the framework of the existing 53-group RUG-III system, along with the use of MDS 3.0.
  
  This approach will allow CMS to make payments with the least disruption for providers and beneficiaries. As we do every year, we will publish the specific payment rates for the upcoming fiscal year in the Federal Register, and provide additional guidance concerning implementation of the FY 2011 payments in the near future. Finally, we note that there is legislation pending in Congress that would repeal section 10325 of the ACA, and thus eliminate the need to retroactively adjust payments.
  
  Using the FY 2010 unadjusted rates and RUG-IV Case-Mix Indexes published in the August 11, 2009 SNF PPS final rule, we have provided example RUG-IV rates for urban facilities. The final RUG-IV rates effective 10/1/2010 will not be available until the final FY 2011 publication of the SNF PPS rates.
• FY 2010 Prospective Payment and Consolidated Billing for Skilled Nursing Facilities; Correction (CMS 1410-CN) is available for download from the List of SNF Federal Regulations web page.  There are two technical corrections to the August 11, 2009 (74 FR 40288) SNF PPS Final Rule:
  • A typographical error in a date on page 40297 which is corrected to say "October 1, 2009" instead of "October 1, 2010"
  • A technical error in the wage index value for rural California which is corrected to "1.2051" instead of "1.2001." 
• RUG-IV Teleconference held on September 15, 2009 is available for download from the Related Links Inside CMS section below.
• FY 2010 CMI Update for Version 5.20S to the Data Specifications for the MDS for Swing Bed Hospitals is available for download from the Swing Bed Providers web page.
• FY 2010 Final rule for Skilled Nursing Facilities PPS (CMS 1410-F) is available for download from the List of SNF Federal Regulations web page.
• Supporting Material to the PPS & Consolidated Billing for SNFs for FY 2010; Final Rule
  • RUG III / RUG IV Distribution Chart is available for download from the Downloads section below.
  • The Sampling Methodology documentation referenced in the FY 2010 PPS and CB for SNF; Final rule is available in the Downloads section of the Time Study (STRIVE) web page.
• CMS FY 2010 SNF Update - New Initiatives in Post Acute Care presentation is available in the Downloads section below.

Downloads
September 1, 2010 National Provider Call Presentation Slides, Short Stay Algorithm, & RUG-IV SNF PPS Case Mix Indices [ZIP, 400KB] RUG-III to RUG-IV transition for the August 24, 2010 audio-conference [ZIP, 16KB] August 24, 2010 National Provider Call Training Presentation Slides [PDF, 175KB] Explanation of FY 2011 Forecast Error Adjustment [PDF, 17.4KB] Distribution of RUG Days Used to Calculate FY 2011 Rates [ZIP, 9KB] June 23, 2010 National Provider Call Transcript [PDF, 105KB] June 23, 2010 National Provider Call Training Presentation Slides [PDF, 179KB] Example RUG-IV Rates for Urban Facilities [ZIP, 9KB] RUG III / RUG IV 2008 Distribution [ZIP, 9KB] CMS FY2010 SNF Update [ZIP, 308KB]
Related Links Inside CMS
June 23, 2010 National Provider Call Audio RUG-IV Teleconference held on September 15, 2009
Related Links Outside CMS
National Provider Call (September 1, 2010) Registration

Page Last Modified: 08/30/2010 11:44:17 AM
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