Our Clinical Toolbox contains information for Individual & Facility Members.
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- Medicare Part A Rules :
- SNF | SNF Explanation of Content
- Inpatient Rehab | Home Health
- Hospital Inpatient
- Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
- 2021 SNF PPS Final Rule for 10/1/20 – Released July 2020
- CMS Wage Index Home Page
- CMS-1737-F Wage Index Tables for FY 2021 – Final (ZIP)
- 2021 SNF PPS Proposed Rule for 10/1/20 – Released April 2020
- CMS Wage Index Home Page
- FY2021 Proposed Wage Index Tables
- Medicare Program Integrity Manual – Chapter 6 PDPM Updates – Nov 2019
- For all PDPM content go to PDPM Resource Center HERE
- PPS MDS and Payment Schedule
- Advanced Beneficiary Notice:
- CMS-R-131 | Denial Letters | SNF ABN 10055
- NOMNC 10123 | DENC 10124
- 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)
- CPT Codes for PT, OT and Speech
- Sample Billing Logs for PT, OT, Speech
- Medicare Part A Weekly Meeting Template
- Med A Triple Check Worksheet
- Therapy Discharge Notice (3 Day Notice to Nursing)
Medicare Part A Archives
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- 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
- KX Modifier Threshold and Manual Medical Review for 2021
- NCCI Edits [National Correct Coding Initiative] as of 10/1/20
- Medicare Part B Edits for SNF, CORF, OPT
- Medicare Part B Edits for Private Practice
- CMS NGS Link To All LCD’s 1/1/20
- PT and OT Outpatient Revised LCD 1/1/20
- PT and OT Coding and Billing LCD Updates 1/1/20
- Speech LCD Updates 1/1/20
- Speech Coding and Billing LCD Updates 1/1/20
- PT and OT Outpatient Revised LCD 1/1/20
- Physician Fee Schedule
- CMS Physician Fee Schedule Home Page
- 2021 (CY2021) Physician Fee Schedule Final Rule (Nov 2020) PDF / FR Link
- All Downloads for PFS Final Rule CY2021
- 2021 (CY2021) Physician Fee Schedule Proposed Rule (Aug 2020) PDF / FR Link
- 2020 (CY2020) Final Rule – Released 11/1/19 (Unpublished Version)
- 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
- SNF CPT Coding PT OT SLP- With AMA Definitions and Coding
- SNF CPT Summary Sheet – PT OT SLP
- 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)
- **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
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- Humana Adopts CMS PTA/OTA Modifier Practice – Humana Resource Document
- CMS Memo 7/26/19 Regarding Manager Medicare MDS HIPPS Codes – PDPM
- CMS Memo 7/1/14 Regarding Managed Medicare MDS HIPPS Codes
- CMS Memo 5/23/14 Update on MDS Requirements
- CMS Memo 12/4/14 Update on MDS HIPPS Codes
- Interpretation of CMS Memo and MDS Implications
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Current RAI Manual and MDS Item Sets:
- MDS-3.0-RAI-Manual-v1.17.1_October_2019-Released 9/18/19
- Technical Specifications MDS – Home Page
- MDS Item Sets for 10/1/2020 – Released 5/19/20
- OBRA: Comprehensive | Quarterly
- PPS: 5 Day Initial Medicare | Part A PPS DC | IPA
- Other: OSA | OBRA DC
- List of all Item Changes
MDS Training By Section:
- Section GG Cross-Setting Training (From CMS – 45 minutes)
- Lesson 1: Importance of Section GG for Post-Acute Care
- Lesson 2: Section GG Assessment and Coding Principles
- Lesson 3: Coding GG0130.Self-Care Items
- Lesson 4: Coding GG0170.Mobility Items
- GG0110. Prior Device Use with Information from Multiple Sources. (3:58)
- GG0130A. Eating. (6:19)
- GG0130B. Oral Hygiene (4:25)
- GG0130H. Putting on/taking off footwear. (6:25)
- GG0170C. Lying to Sitting on side of bed. (4:33)
- GG0170L. Walking 10 feet on uneven surfaces. (5:52)
- GG1070P. Picking up object. (5:49)
- Decision Tree for Coding Section GG0130. Self-Care and GG0170. Mobility. (11:56)
- GG Self-Care & Mobility Activities Decision Tree (PDF)
- Section C:
- Confusion Assessment Method (CAM©) Video Tutorial from CMS
- Brief Interview for Mental Status (BIMS) Video Tutorial from CMS
- Section M: Skin Conditions – Assessment and Coding of Pressure Ulcers/Injuries Web-Based Training from CMS
- Section N: Medications – Drug Regimen Review Web-Based Training from CMS
- Section J: Health Conditions: Coding the Standardized Patient Assessment Data Elements (SPADEs) Related to Falls
Custom Tools and Resources:
- Montero Section GG: Admission/DC Self Care & Mobility Data Collection Tool
- Section G Balance and ROM
- Interpretation of Section G: Balance and ROM
- 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) – Used by RUG payers
- PPS MDS and Payment Schedule – Used by RUG payers
- ADL Score Determination | Algorithm | Calculation
- MDS Correction Algorithm
- RAI Coordinator By State – Updated 2020
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- CMS Home Page for ICD-10-CM Information
- CMS Guidelines for Coding – 2021
- 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
- SNF CPT Coding – With AMA Definitions and Coding
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- CMS QM Home Page
- QM Users Manual- Zip File of All Components – 10/19/20
- MDS 3.0 Quality Measures User’s Manual – Effective 10/1/20
- Appendix A of QM User’s Manual – Lists Measures Detail
- List of All Short Stay Measures vs Long Stay Measures
- CMS SNF Nursing Home Compare Database
- CMS SNF Nursing Home Provider Database
*Montero Custom Quality Measures – Cheat Sheet
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- CMS SNF QRP Home Page
- CMS Video Summary of SNF QRP
- SNF Quality Reporting Program Spotlights & Announcements
- SNF Quality Reporting Program Training
- SNF Quality Reporting Program Public Reporting
- SNF Quality Reporting Program Measures and Technical Information
- Measures
- SNF QRP Measure Calculation and Reporting User’s Manual – Updated 8/2019
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- SNF Measure Calculations and Reporting User’s Manual V3.0_FINAL_508C_081419 (PDF)
- Addendum & Change Table for SNF-QRP-Measure-Calculations-and Reporting-User’s-Manual-V3.0.1 Effective-10-01-2020
- SNF QM User’s Manual V3.0 Change Table_8-9-19_508C (PDF)
- SNF QRP – Old Manuals:
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- SNF QRP Users Manual 10/1/18 (Measures & Calculation)
- SNF QRP Change Tables (2018)
- SNF Quality Reporting Users Manual 2017
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- Potential 2% Penalty
- SNF QRP – MDS Questions Triggering Penalty for Lack of Data / Dashes
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SNF QRP Table for Reporting Assessment-Based Measures for the FY 2021 SNF QRP APU (PDF)
- SNF-QRP-Table-for-Reporting-Assessment-Based-Measures-for-the-FY-2022-SNF-QRP-APU (PDF)
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- SNF QRP – MDS Questions Triggering Penalty for Lack of Data / Dashes
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- SNF QRP Data Submission Deadlines
- FY2021
- FY2022
*Montero Custom Quality Measures – Cheat Sheet
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- CMS SNF VBP Program Overview and Home Page
- SNF VBP Program’s Hospital Readmission Measure – Details and Updates
- SNF VBP FAQ Document – August 2020
- SNF VBP FAQ Document – April 2019
- SNF VBP FAQ Document – June 2018
- SNF VBP Score Overview – CMS YouTube Video
- CMS – Accessing SNF VBP Confidential Reports – Instructions/Tutorial
- Understanding the SNF VBP Report – Tutorial
- SNF VBP – Understanding Confidential Feedback Report
- MLN article (PDF) about the Program
- Public Reporting of SNF VBP Program Data
- SNF VBP Program data are publicly available HERE and HERE
- FY 2020 SNF VBP Facility-Level Dataset – See Data for All SNF’s
- Source of SNF VBP Rules: FY 2021 Final Rule
- 2019 Novel Coronavirus (COVID-19) Pandemic Changes
*Montero Custom Quality Measures – Cheat Sheet
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- Nursing Home Compare
- What is Nursing Home Compare and How Can It Help You?
- *Nursing Home Compare – Find Your SNF’s STAR Rating
- CMS SNF Nursing Home Compare Database
- CMS SNF Nursing Home Provider Database
- Learn How Ratings are Calculated
- View Long Term Care (LTC) Facility Staffing Payroll-Based Journal (PBJ) data
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- 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
- 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
- Jimmo Updates 1/1/20
- 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, 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
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- State Operations Manual
- Major Manual Update – New F-Tag Labels (Index)
- CMS Transmittal November 2017 – All new F-Tags
- Key Components for Therapists (Pre-2017 update)
- State: PT, OT, Speech
- State Operations Manual
- Therapy Information, F Tags
- 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)
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- 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
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SURVEY INTERVIEW AND OBSERVATION QUESTIONS & PROBES
- State Survey RESIDENT OBSERVATION Care Areas and Probes
- State Survey RESIDENT INTERVIEW Care Areas and Probes
- State Survey FAMILY INTERVIEW Care Areas and Probes
- State Survey RECORD REVIEW Care Areas and Probes
- State Survey Procedure Guide 2020
- State Survey LTCSP Mapping Document 2020
- State Survey List-of-Revised-FTags 2020
- State Survey CMS F-Tag Crosswalk 2020
OTHER TOOLS AND RESOURCES
- State Survey Entrance Conference Form
- Survey Preparation Tool for Therapy Staff
- State Survey – CMS Form 672 – Data Collection and Instructions
- State Survey – CMS Form 802 – Data Collection and Instructions
- Survey Resources – UPDATED 11/25/2020 (ZIP)
- Revision History for LTC Survey Process Documents and Files UPDATED 11/25/2020 (PDF)
- State Operations Manual – Main Page
- Link to CMS State Operations Manual – Appendix PP
CRITICAL ELEMENT PATHWAYS: FORMS SURVEYORS USE TO AUDIT EACH AREA
PRINT / SAVE INDIVIDUAL PATHWAYS FROM LIST BELOW:
- SNF Beneficiary Protection Notifications NOMNC ABN
- Dining Observation
- Infection Prevention, Control & Immunizations
- Kitchen Observation
- Medication Administration Observation
- Resident Council Interview
- Quality Assessment and Assurance (QAA) and Quality Assurance and Performance Improvement
- Abuse
- Environmental Observations
- Sufficient and Competent Nurse Staffing Review
- Personal Funds Review
- Activities
- Activities of Daily Living (ADL)
- Behavioral and Emotional Status
- Urinary Catheter or Urinary Tract Infection
- Communication and Sensory Problems (Includes Hearing and Vision)
- Dental Status and Services
- Dialysis
- General Care
- Hospice and End of Life Care and Services
- Death
- Nutrition
- Pain Recognition and Management
- Physical Restraints
- Pressure Ulcer/Injury
- Specialized Rehabilitative or Restorative Services
- Respiratory Care
- Unnecessary Medications, Psychotropic Medications, and Medication Regimen Review
- Medication Storage and Labeling
- Preadmission Screening and Resident Review
- Extended Survey
- Hydration
- Tube Feeding Status
- Positioning, Mobility & Range of Motion
- Hospitalization
- Bladder or Bowel Incontinence
- Accidents
- Neglect
- Resident Assessment MDS
- Discharge Planning
- Dementia Care
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- CMI Calculator – NYS
- NYS 2020 Case Mix Census Dates and Roster Upload Info
- NYS CMI Instructions on New Collection Process for 2020
- NYS MDS Clarification Document
- NYS Dementia / BMI Add-0n Regulations – Criteria
- NYS Public Health Law
- NYS MDS Roster Submission Op Cert Form
- NYS HCS Access Request Form
- NYS Section S Instructions
- NYS Section S Payer Rules
- NYS Managed Medicaid Manual
- Respiratory Therapy MDS Audit Tool
- NYS CMI Rules – Published 2008 (Currently active)
- Older NYS CMI DAL’s
- 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
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- 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 | SNF ABN 10055
- NOMNC 10123 | DENC 10124 | NEMB SNF 20014
- Breakdown of Requirements for each form
…and MORE…
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