Our Clinical Toolbox contains information for 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
- 2020 SNF PPS Final Rule for 10/1/19 – Released 4/19/19
- 2019 SNF PPS Final Rule (FY 2019) Released 7/31/18
- *Includes Patient Driven Payment Model for 10/1/19
- Montero Green Sheet – RUG IV
- 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:
- 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)
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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
- 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
- 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
- 2021 (CY2021) Physician Fee Schedule Proposed Rule (Aug 2020) PDF / FR Link
- Physician Fee Schedule LOOK UP TOOL
- SNF CPT Code Outline with Fee Set Up
- SNF CPT Coding – With AMA Definitions and Coding
- 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)
- 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 *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
- SNF CPT Coding – With AMA Definitions and Coding
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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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- 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
- ***All 10/1/2020 MDS Changes are on hold per CMS – Released March 2020
- Draft MDS Item Sets for 10/1/2020 (Released 12/20/19) – **No longer valid – See above
- NC Comprehensive
- NQ Quarterly
- OBRA DC
- Part A PPS DC
- PPS (5 day)
- IPA
- OSA
- Tracking
- Draft MDS Item Sets for 10/1/2020 (Released 12/20/19) – **No longer valid – See above
- MDS 3.0GeneralChangeTable_v1.17 to v1.17.1 [PDF, 126KB] – Released 9/18/19
- MDS 3.0 RAI Manual v1.17.1 Replacement Manual Pages and Change Tables_October 2019 [PDF, 16MB]-Released 9/18/19
- MDS 3.0 RAI Manual v1.17.1 and Change Tables_October 2019_Part_2 [ZIP, 12MB]-Released 9/18/19
- MDS 3.0 RAI Manual v1.17.1 and Change Tables_October 2019_Part_1 [ZIP, 15MB]-Released 9/18/19
- MDS 3.0 RAI Manual v1.17.1 and Change Tables_October 2019_Part_3 [ZIP, 9MB]-Released 9/18/19
- MDS3.0_Final_Item_Sets_v1.17.1_for Oct_1_2019 [ZIP, 4MB]-Released 9/18/19
- (Old) MDS3.0_Final_Item_Sets_v1.17.1_for Oct_1_2019 [ZIP, 4MB]-Released 9/18/19
- Final RAI Manual for October 2019 – Released May 2019 (Newer version above released Sept 2019)
- (Old) DRAFT Item Sets for 10/1/19 **Released January 2019 (Final versions above)
- 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
- 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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- 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 – 10/19/20
- CMS Measures – Summary Chart
- Short Stay Quality Measures
- Long Stay Quality Measures
- CMS SNF Nursing Home Compare Database
- CMS SNF Nursing Home Provider Database
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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
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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
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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 Resources (Zip file)
- Revision History Document – LTC Survey Process
- 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
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- 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
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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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