Review and Corrections Deadline Rapidly Approaching

April 1, 2019 is the deadline to review and submit correction requests to the Centers for Medicare and Medicaid Services (CMS) regarding quality measure information from Calendar Year (CY) 2017 stay-level data for the Fiscal Year (FY) 2019 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program.

CMS held a call on Wed., March 20, 2019 to discuss the SNF VBP Program Phase One Review and Corrections process. During Phase One of the process, SNFs have the opportunity to submit correction requests to their quality measure information. The VBP measure is SNF 30-Day All-Cause Readmission Measure (SNFRM). A facility’s Traditional Medicare A reimbursement from FY 2019 claims is dependent on an incentive multiplier, which is assigned to a facility based on its performance on the VBP measure or improvement in its performance on the measure, whichever is the better of the two. Both hospital and SNF claims data are utilized to calculate the measure. During the question and answer period of the call, there were two recurring themes: (1) how the readmission is classified as planned versus unplanned; and (2) how the Medicare A rate is calculated. CMS classifies readmissions as planned or unplanned. The measure does not take Minimum Data Set (MDS) 3.0 Version 1.16.1 item A0310G (Type of Discharge) 1 or 2 (Planned or Unplanned) into consideration. A quick reference Readmission Algorithm can be accessed here. The process for submitting claims to the facility’s Medicare Administrative Contractor (MAC) has not changed because of the SNF VBP Program. The facility submits the claim to its MAC using the adjusted per-diem rate, and the MAC then calculates the rate using the SNF VBP incentive multiplier, among other adjustments. For a quick reference guide to steps in the SNF Medicare A rate calculation, click here.

Questions about the SNF VBP Program may be submitted to SNFVBPinquiries@cms.hhs.gov.

Contact: Susan Chenail, schenail@leadingageny.org, 518-867-8383 ext. 116