Manuals:
- Summary:
- Explanation of Manual Set Up and Content
- Medicare Part A Rules :
- SNF | SNF Explanation of Content
- Inpatient Rehab | Home Health
- Hospital Inpatient
- Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
- Medicare Part B Rules (SNF, Hospital Outpatient)
- Part B Explanation of Content
- Evaluations | Progress Reports | Daily Treatment Encounter Note
- Re-Certifications | Discharge Reports
- Part B Explanation of Content
- State Operations Manual (Updated 11/22/17)
- Major Manual Update – New F-Tag Labels (Index)
- CMS Transmittal November 2017 – All new F-Tags
- Key Components for Therapists (Pre-2017 update)
- RAI Manual
- Final RAI Manual for October 2019 – Released May 2019
- For all PDPM content go to PDPM Resource Center HERE
- Technical Specifications MDS – Home Page
- DRAFT MDS Data Specs for 10/1/19 (Released 2/5/19) Zip File
- See below for DRAFT Item Sets for 10/1/19 (Released 1/19)
- Final RAI Manual for October 2018 – Released August 2018
- New Manual Pages
- Item Set Changes (zip file)
- New MDS: Comp | Quarterly | PPS | NPE Part A PPS DC
- New Section GG Updates 10-1-18
- Section GG Self Care and Mobility Decision Tree
- CMS Section GG Coding Tutorial
- Final RAI Manual for October 2017 Released August 2017
- New Manual Pages (439 total)
- New Item Sets: Comp | Non-Comp | PPS
- What’s New?
- RAI Manual for October 2016 Released 8/25/16
- 8/10/16 CMS posted the new MDS 3.0 item sets (assessment forms) v1.14.1. These will go into effect 10/1/16.
- PPS 5,14,30,60,90 Day | Quarterly | Comprehensive | Part A Discharge | Facility Discharge
- *Draft RAI Manual for October 2016 Release
- MDS 3.0 Manual (Updated 10/2015- zip file)
- Replacement Manual Pages (Updated 10/2015- zip file)
- Explanation of October 1st 2014 Changes
- CMS COT Clarification Memo
- COT Case Examples
- Coding
- ICD-10-CM Tabular List of Disease and Injury from CMS.gov
- ICD-10-CM Index List of Disease and Injury from CMS.gov
- ICD-10 Code Look-up Tool from CMS.gov
- Quality Measures
- CMS QM Home Page
- QM Users Manual – 4/1/17
- Cheat-sheet for: QM – 5 Star – Nursing Home Compare – Survey
- SNF Quality Reporting Program
- CMS SNF QRP Home Page
- SNF QRP Measures and Technical Information – Summary Page
- SNF QRP Users Manual 10/1/18 (Measures & Calculation)
- SNF QRP Change Tables (2018)
- SNF QRP Technical Specifications for Measures FY2019
- SNF QRP FY2020
- SNF Quality Reporting Users Manual 2017
- SNF Value Based Purchasing
- CMS SNF VBP Home Page
- SNF VBP FAQ Document – June 2018
- SNF VBP Score Overview – CMS YouTube Video
- CMS – Accessing SNF VBP Confidential Reports – Instruction
- SNF VBP – Understanding Confidential Feedback Report
- Nursing Home Compare
MDS 3.0 Resources:
- For all PDPM content go to PDPM Resource Center HERE
- Final RAI Manual for October 2019 – Released May 2019
- DRAFT Item Sets for 10/1/18 **Released January 2018
- PPS 5 Day
- NPE Medicare Part A PPS Discharge
- Comprehensive
- Quarterly
- OBRA Discharge
- IPA (Interim Payment Assessment)
- OSA (Optional State Assessment)
- Item set Changes – Tables
- Section GG Self Care and Mobility Decision Tree
- CMS Section GG Coding Tutorial
- **MDS Changes for Oct 1 2018
- 5 Day PPS MDS (10/1/18)
- PPS Discharge (10/1/18)
- Comprehensive
- Quarterly
- OBRA Discharge
- CMS Q&A Fact Sheet on 10/1/16 MDS Changes and QRP
- Section GG: Admission/DC Self Care & Mobility Data Collection Tool
- Section G Balance and ROM
- Interpretation of Section G: Balance and ROM
- MDS 3.0 Forms: Quarterly, Comprehensive, PPS, SOT, OMRA, Discharge , Part A Discharge
- Section O Therapy Days and Minutes
- Interpretation of Section O: Therapy Minutes, Days and Dates
- Section O: Restorative Nursing
- Respiratory Therapy MDS Audit Tool
- PPS MDS Short Stay Algorithm (Updated 10/2015)
- PPS MDS and Payment Schedule
- ADL Score Determination | Algorithm | Calculation
- PPS MDS COT Algorithm
- MDS Correction Algorithm
Reimbursement – Medicare Part A:
- For all PDPM content go to PDPM Resource Center HERE
- 2020 SNF PPS Final Rule – Released 7/30/19
- 2020 SNF PPS Proposed Rule – Released 4/19/19
- 2019 SNF PPS Final Rule (FY 2019) Released 7/31/18
- *Includes Patient Driven Payment Model for 10/1/19
- 2019 SNF PPS Proposed Rule (FY 2019) Released 4/27/18
- New Part A Payment Model Proposed for 10/1/19 – Patient-Driven Payment Model
- Home Page
- Rule/Document
- Acumen Technical Report
- New Part A Payment Model Proposed for 10/1/19 – Patient-Driven Payment Model
- Archived SNF PPS Final Rules
- 2018 SNF PPS Final Rule (FY 2018)
- **New 4/28/17 – Proposed SNF New Payment Model – No RUGS
- 2018 SNF PPS Proposed Rule (FY 2018)
- 2017 SNF PPS Final Rule (FY 2017) PDF Version
- Urban and Rural Rates 2017
- 2017 SNF PPS Proposed Rule (FY 2017)
- 2016 SNF PPS Final Rule (FY 2016)
- 2016 SNF PPS RUG IV Rates
- 2016 SNF Proposed Rule
- 2015 SNF PPS RUG IV Rates
- 2015 SNF PPS Final Rule (FY 2015)
- PPS MDS and Payment Schedule
- Advanced Beneficiary Notice:
- CMS-R-131 | Denial Letters | SNF ABN 10055
- NOMNC 10123 | DENC 10124 | NEMB SNF 20014 (Discontinued 2018)
- Breakdown of Requirements for each form
- What is Skilled Therapy Fact Sheet
- SNF Billing Fact/Reference Sheet
- SNF Part A Certification and Recertification Requirements (for SNF stay)
- Therapy Schedule and Minute Tracker (sample)
- PPS 100 Day Tracker Sample 1 | Sample 2
- MDS Therapy Data Sheet
- Statistics and Report Forms
- ICD-10-CM Code List: LTC Therapy Most Common Codes (New 10/1/15)
- ICD9 Code List: LTC Therapy Most Commonly Used Medical Dx
- ICD9 Code List: LTC Therapy Most Commonly Used Treatment Dx
- CPT Codes for PT, OT and Speech
- Sample Billing Logs for PT, OT, Speech
- Medicare Part A Weekly Meeting Template
- PPS MDS COT Algorithm
- Med A Triple Check Worksheet
- Therapy Discharge Notice (3 Day Notice to Nursing)
Reimbursement – Medicare Advantage Managed Care / HMO:
- CMS Memo 7/1/14 Regarding Managed Medicare MDS HIPPS Codes
- CMS Memo 5/23/14 Update on MDS Requirments
- CMS Memo 12/4/14 Update on MDS HIPPS Codes
- Interpretation of CMS Memo and MDS Implications
Reimbursement- Medicare Part B:
- Physician Fee Schedule
- CMS Home Page for 2019
- 2020 Proposed Rule – Released 7/30/19
- 2019 Final Rule – Released 11/23/18
- 2019 Proposed Rule – Released 7.27.18
- Archived Rules
- 2018 Final Rule
- 2018 Proposed Rule | CMS Fact Sheet
- 2017 Final Rule
- 2017 Proposed Rule Background Info | Rule | FR
- 2016 – Final
- 2015 – Final
- 2014 – Final
- Physician Fee Schedule LOOK UP TOOL
- 2018 Therapy Cap (Discontinued 1/1/18)
- Med B Therapy Cap (Discontinued 1/1/18)
- Med B Functional Limitation Reporting / G Codes (Discontinued by CMS 1/1/19)
- Advanced Beneficiary Notice Forms CMS-R-131
- When to use and not to use
- Statistics and Report Forms
- Proper use of Modifier 59
- ICD-10-CM Code List: LTC Therapy Most Common Codes (New 10/1/15)
- CPT Codes for PT, OT, SLP *Updated with 2018 Changes
- **New CPT Therapy Evaluation Codes 1/1/17
- PT and OT Decision Chart for CPT Evaluation Codes by Complexity
- PT Decision Chart and Documentation Tool – Eval Codes by Complexity
- OT Decision Chart and Documentation Tool- Eval Codes by Complexity
- Med B Triple Check Worksheet
Clinical Information:
- Documentation:
- Fact Sheet: Requirements for Med A vs Med B
- Evaluation Templates (Medicare Compliant)
- PT | OT | Communication | Swallowing
- Progress Report Templates
- PT | OT | Communication | Swallowing
- Daily Treatment Encounter Note Templates
- PT | OT | Communication | Swallowing
- Dysphagia Plan of Care Template
- Home Evaluation Forms
- G-Codes (Discontinued by CMS 1/1/19)
- Total Hip Replacement Precaution Sheet
- Objective Tests and Measures
- Tinetti Test
- Berg Balance Test
- Functional Reach Test
- Single Leg Stance Documentation Flow Sheet
- Tandem Stance Documentation Flow Sheet
- Sit to Stand Test Documentation Flow Sheet
- 4 Square Step Test Documentation Flow Sheet
- Maintenance Therapy Rules
- Jimmo Fact Sheet
- ICD-10-CM Code List: LTC Therapy Most Common Codes (New 10/1/15)
- CPT Codes for PT, OT, SLP
- **New CPT Therapy Evaluation Codes 1/1/17
- PT and OT Decision Chart for CPT Evaluation Codes by Complexity
- PT Decision Chart and Documentation Tool – Eval Codes by Complexity
- OT Decision Chart and Documentation Tool- Eval Codes by Complexity
- What is Skilled Therapy Fact Sheet
- Skilled Therapy – Action Word Documentation List
- Lab Values: Norms for Geriatric Population
Compliance:
- Practice Act By State: PT, OT, Speech
- State Operations Manual
- Audit Tools for Documentation, Chart Review
- Sample ADR Response Appeal Letter Sample 1 | Sample 2
- Fact Sheet: Documentation Requirements for Med A vs Med B
- Contractures vs MDS Section G ROM
- What is Skilled Therapy: Fact Sheet
- APTA/AOTA/ASHA Consensus Statement on Clinical Judgment/Ethics
- CMS Targeted Probe and Educate (TPE) Audits (New August 2017)
Department Management:
- Medicare Part A / Discharge Planning Meeting Template
- Therapy Schedule and Minutes Tracker
- Billing and Tracking Forms: PT | OT | SLP
- Statistics and Report Forms
- Triple Check Meeting Forms Part A Part B
- Sample ADR Response Appeal Letter Sample 1 | Sample 2
State Survey Information:
- Census and Conditions Report – 672
- Facility Matrix – 802
- QIS Survey Resources and Guides
- List of QIS Survey Forms
- Resident Interview and Observation
- Staff Interview
- ADL Pathway
- Restraints
- Rehab and Restorative
- Range of Motion
- Positioning
- Communication
- Dementia Care Checklist
- QIS Process Update Brochure (July 2015)
- Surveyor Desktop References (July 2015)
- QIS Fact or Fiction (July 2015)
- List of QIS Survey Forms
- Complete list of F Tags
- Survey Preparation Tool for Therapy Staff
State Case Mix:
- State Case Mix Map: Medicaid
- CMI Calculator – NYS
- NYS 2017 Case Mix Census Dates and Roster Upload Info
- NYS 2016 Case Mix Census Dates and Roster Upload Info
- NYS 2015 Case Mix Census Dates and Roster Upload Info
- NYS Dementia / BMI Add-0n Regulations – Criteria
- NYS Public Health Law
- NYS MDS Roster Submission Op Cert Form
- NYS HCS Access Request Form
- Respiratory Therapy MDS Audit Tool
Nursing:
- ADL Score Determination
- Algorithm
- Calculation
- Restorative Nursing Information
- Documentation Template
- Respiratory Therapy MDS Audit Tool
- What is Skilled Nursing: Fact Sheet
- Triple Check Meeting Forms
- PPS MDS COT Algorithm
- RAI State Coordinators List
- Contractures vs MDS Section G ROM
- PPS 100 Day Tracker Sample 1 | Sample 2
- Laboratory Values: Norms for Geriatric Population
- Nurse Aide Worksheet: Template
- Advanced Beneficiary Notice:
- CMS-R-131 | Denial Letters (Discontinued 2018) | SNF ABN 10055
- NOMNC 10123 | DENC 10124 | NEMB SNF 20014 (DC 2018)
- Breakdown of Requirements for each form
