Timely updates about the healthcare industry

New law eliminates access to FL Medicaid claims portal

New changes to the Agency for Health Care Administration (AHCA) in Florida could impact your practice’s claims submission and remit processes. CS/HB 1057, signed into law in June, eliminates parts of the AHCA’s requirements for Medicaid reporting. As part of those changes, Florida providers will no longer have access to CMS’ free Medicaid reporting portal.1

The changes included in the bill come with some good news and some challenges, as some providers will need to adjust in order to make reports and submit claims through clearinghouses, rather than directly through the Medicaid portal. Let’s take a look at what’s changing and how you can prepare for the measure, which took effect July 1.1

What’s in the new law?

The good news is that it eliminates some reporting requirements that have been in effect for several years. Providers will no longer need to report on:

  • Medicaid Managed Care Transition
  • Pharmaceutical Expense Assistance Program
  • Medicaid Drug Spending Control Program

The first of these requirements, Medicaid Managed Care Transition Report, was implemented in the transition from traditional Medicaid programs to the new Medicaid Managed Care program. Since this transition has been complete for the last seven years, this report is now redundant and can be ended.1

The Pharmaceutical Expense Assistance Program Report only applies to Medicaid recipients who have been eligible since 2006 or earlier. There are now only 14 patients still eligible for this assistance in Florida, and while they will continue to enjoy eligibility, reporting on this program is no longer necessary.

Finally, the Medicaid Drug Spending Control Program is another legacy reporting requirement that was implemented in the transition from Medicaid Fee-for-Service (FFS) to the new model. Because much of the eligible population for this program has dual eligibility with Medicare and may also be receiving medications through skilled nursing facilities, the data collected from this report may not be an accurate reflection of medication spending trends for the Medicaid population.

What does the law mean for your healthcare organization?

While Florida providers are now no longer responsible for these reporting requirements, the bill also eliminates access to the free portal for Medicaid claims submissions. Instead, providers must send those claims through a clearinghouse connecting them indirectly to federal payers.

Fortunately, ABILITY works with organizations in Florida and across the country to simplify claims submission and remit processes – bringing all submissions together through a single, centralized portal for all payers.

To learn more about how ABILITY can help you automate claims submissions, decrease denials and streamline remits, request a demo today.


1.“New bill revises AHCA Medicaid practices,” Nicole Pasia, State of Reform, June 22, 2021. https://stateofreform.com/news/florida/2021/06/new-bill-revises-ahca-medicaid-practices/

ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.

Overcoming the biggest challenges facing skilled nursing facilities today

Over the last few years, skilled nursing facilities have been put through the wringer as they’ve grappled with a new Medicare payment model, higher acuity patients, declining reimbursements, increased regulatory scrutiny and most recently, the COVID-19 pandemic and staff turnover.

Staying afloat in this ever-changing post-acute care industry can be an uphill battle; however, it is not insurmountable. Adopting technology to simplify quality management is key to remaining financially viable while delivering high quality care.

Here are the four most significant clinical burdens SNFs are facing today, with tips on how your organization can overcome them.

Challenge #1: Maintaining clinical quality performance

SNFs are caring for patients with greater medical complexity as the overall population ages and hospitals discharge ill patients sooner. Higher acuity rates strain SNF resources and require higher staffing levels to maintain quality care.

At the same time, facilities must report key performance indicators required by CMS and reflected in the regulatory agency’s Five-Star Quality Rating System to assess quality, such as:

  • Daily staffing levels via the Payroll-Based Journal (PBJ) system
  • Several different Quality Measures (QMs) related to the physical and clinical needs of residents
  • Results from recent health inspections based on CMS minimum quality requirements

Tip: Implement technology that streamlines quality reporting and monitoring and offers data insights for continuous performance improvement.

Challenge #2: Keeping up with changing reimbursement policies

Reimbursements are the financial lifeblood of SNFs – so there’s no question the stress of staying afloat in the face of changing and diminishing reimbursements is real.

The Patient Driven Payment Model (PDPM), for example, upended how SNFs were accustomed to being reimbursed, by shifting from payments based on volume to quality.

Though the industry is acclimated to the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program, which rewards facilities with incentive payments linked to the quality of care they provide to their fee-for-service Medicare patients, changes may be coming.

The Medicare Payment Advisory Commission (MEDPAC) recently recommended to Congress the elimination of the current SNF VBP program in favor of a new value incentive program (VIP). The new initiative would include several quality measures, a change in distribution of rewards, and would account for differences in patients’ social risk factors.

Tip: Use an application that helps you manage PDPM and SNF VBP revenue, keeps you up to date with changing policies and provides real-time and predictive reporting.

Challenge #3: Staying accountable and compliant

When it comes to regulatory compliance, documentation integrity and accountability are key. With SNFs under increased scrutiny in light of the COVID-19 pandemic, these factors have taken on greater weight.

The Triple Check Process is fundamental to ensuring billing accuracy and compliance with regulatory guidelines. Because of all the steps involved, there is a lot of room for error.

A properly conducted Triple Check ensures medical necessity and diagnoses are supported by clinical documentation, and MDS assessments are submitted on time and match the UB-04. Getting this process right means the difference between a paid and unpaid claim.

Tip: Automate this time-consuming process to ensure MDS accuracy before assessment and submission.

Challenge #4: Managing operational burdens

The pandemic has magnified the operational issues of the post-acute industry. SNFs face daily operational challenges and risks, such as retaining adequate staffing, ensuring the safety of workers and residents, managing infection control, and operating on thin margins.

A recent survey conducted by the American Healthcare Association and National Center for Assisted Living found that 65% of post-acute facilities are currently operating at a loss and 90% have profit margins of 3% or less. In fact, as many as 66% say they could close in 2021 because of COVID-19 costs.

Tip: Find a platform that helps you oversee operations, minimizing risk and infection incidence while boosting efficiencies for a better bottom line.

Thriving through the changes

Fortunately, your facility doesn’t have to face these challenges alone. With ABILITY, you have access to one suite of applications that keeps patient care at the forefront and helps your skilled nursing business thrive.

Prefer a visual depiction of the challenges and solutions? Check out our handy infographic now.

ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.

Medicare simplifies home health claims, phasing out RAPs

The Centers for Medicare & Medicaid Services (CMS) announced that its phase-out of requests for anticipated payments (RAPs) will be complete in 20221, simplifying the process of billing home health care delivered to Medicare patients by Home Health & Hospice Medicare Administrative Contractors (MACs). Instead of the RAP, home health agencies (HHAs) will submit a one-time notice of admission (NOA) to mark the beginning of a period of care.

Understanding the change

When billing Medicare contractors for home health care, HHAs currently have to submit one RAP for every 30-day period of care (POC) for the duration of the patient’s episode of care. With the full phase-out of RAPs, HHAs will begin submitting NOAs when billing Home Health & Hospice MACs. CMS will require HHAs to submit one NOA for any series of HH POCs, beginning with admission and ending with patient discharge. The NOA will cover contiguous 30-day periods of care. If a patient is discharged from home health care but later qualifies for home health services, the provider will have to submit a new NOA.

Billing with NOAs

Under the change, HHAs must submit a NOA within the first five days of a period of care using TOB 32A. After the NOA has been submitted, HHAs will use TOB 329 to report POC. As of Jan. 1, 2022, TOB 329 will be reclassified to an original claim from an adjustment. HHAs are able to submit NOAs to Home Health & Hospice Medicare Administrative Contractors by mail, Electronic Data Interchange or Direct Data Entry. When submitting NOAs through an Electronic Data Interchange, HHAs will need to submit additional data beyond the requirements of the NOA to satisfy CMS transaction standards.

ABILITY has adapted its applications to accommodate the billing change. As ABILITY EASE Medicare has done with hospice notice of election (NOE) claims, the application now allows users to submit NOAs in bulk through batch submissions. That allows providers to submit their NOAs on time to reduce timely filing penalties.

For patients who are already enrolled in home health care as of Jan. 1, 2022, HHAs must submit a one-time NOA listing an artificial admission date with the period of care beginning in 2022.

CMS will implement a reduction in payment for non-timely NOA submission. Payments will be reduced by 1/30 of the wage rate for each day past the five-day filing window that the NOA is late. If an HHA does miss the filing deadline, they are able to request an exception from CMS to avoid the reduction in payment.

Discover how ABILITY EASE Medicare can assist your agency today.


1. “Replacing Home Health Requests for Anticipated Payment (RAPs) with a Notice of Admission (NOA) – Manual Instructions.” MLN Matters, June 9, 2021. www.cms.gov/files/document/mm12256.pdf

ABILITY and design®, ABILITY® and ABILITY EASE® are trademarks of ABILITY Network, Inc.

Long-term care facilities now required to report COVID-19 vaccinations under new CMS rule

Long-term care facilities must now have programs in place to deliver COVID-19 vaccinations to all residents and staff who wish to receive them and provide information on the benefits of the vaccine, according to an interim final rule announced earlier this month by the Centers for Medicare & Medicaid Services (CMS)1.

The interim rule also mandates that facilities report staff and resident vaccinations weekly to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN). The information garnered through the reporting will help to identify facilities that require additional support in providing education and vaccines.

COVID-19 vaccination reporting requirements

COVID-19 vaccination reporting requirements apply to long-term care facilities, as well as intermediate-care facilities for individuals with intellectual disabilities. The new requirements are in addition to existing requirements to report COVID-19 testing, case and mortality data to the NHSN. They mirror existing reporting requirements for influenza and pneumococcal vaccines for long-term care facilities and carry similar penalties for noncompliance2 – $1,000 for the first failure to report and $500 per week for each subsequent failure.

Reporting requirements apply to all residents, as well as staff who work regularly within the facility.

Benefits of reporting vaccination data

According to CMS1, tracking of COVID-19 data will allow NHSN to identify facilities that need additional support in providing vaccinations and vaccine education to residents and staff. That support is especially important, CMS officials said, because of how hard hit residents and staff of Long-Term Care Facilities have been by COVID-19 infections and deaths. CMS officials also acknowledged that staff turnover at long-term care facilities can make effective vaccine programs a challenge, with programs requiring additional vaccine efforts as new staff members come on board.

Leveraging technology for easier vaccine reporting

Though the new reporting requirement places added burden on often short-staffed teams, technology can help facilities comply with the new rule and avoid penalties. ABILITY INFECTIONWATCH provides for easy reporting of COVID-19 vaccination data. The application enables COVID-19 vaccination reporting with:

  • Single-button access to accurate vaccination data for residents and staff
  • Exportable Excel/CVS files for quick copying and pasting of line listings and antibiotic usage reports available into NHSN templates
  • Tracking of what has and has not been reported to NHSN
  • A centralized hub for all vaccination data

Learn more about how your long-term care facility can meet COVID-19 vaccination reporting requirements with ABILITY INFECTIONWATCH.


1. CMS Expanding Efforts to Grow COVID-19 Vaccine Confidence and Uptake Amongst Nation’s Most Vulnerable,” Centers for Medicare & Medicaid Services, May 11, 2021, https://www.cms.gov/newsroom/press-releases/cms-expanding-efforts-grow-covid-19-vaccine-confidence-and-uptake-amongst-nations-most-vulnerable
2. Flynn, Maggie, “CMS Requires Nursing Homes to Report Staff and Resident COVID-19 Vaccination Status,” Skilled Nursing News, May 11, 2021, https://skillednursingnews.com/2021/05/cms-requires-nursing-homes-to-report-staff-and-resident-covid-19-vaccination-status/


ABILITY and design®, ABILITY® and ABILITY INFECTIONWATCH® are trademarks of ABILITY Network, Inc.

New HETS updates to include latest COVID-19 vaccine data, code changes and more

Important updates are coming to HETS, the eligibility verification system used by healthcare providers to interact with Medicare. The changes will feature updates on COVID-19 vaccine administration, beneficiary entitlement reason codes, acupuncture benefits reimbursement and pneumococcal vaccine (PPV) service histories.

The updates, which are expected to go into effect April 3, are fully detailed in the CMS HETS Companion Guide.

COVID-19 vaccinations

One of the most significant HETS updates deals with COVID-19 vaccinations. Medicare will deliver the most recent information for vaccinations and vaccine administration. Vaccine administration can be rendered under Medicare Part A or Medicare Part B. The updated eligibility responses might include:

  • Applicable Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code(s) for each COVID-19 immunization
  • Immunization dates for each CPT or HCPCS code
  • Rendering provider NPI for each CPT or HCPCS code

Consistent nomenclature for Medicare Advantage (MA)

To create more consistent terminology across the Medicare Advantage (MA) program, this update will include changes to HETS language that will be carried forward. Currently, HETS documents use both MA and Managed Care Organization (MCO) terminology. Beginning with this release, HETS documentation will change all MCO references to the MA terminology.

Entitlement reason codes

The HETS updates will bring changes to entitlement reason codes for Medicare Part A and Part B coverage when the data is available. The entitlement reason codes are:

  • 0: Beneficiary insured due to age Old-Age and Survivors Insurance
  • 1: Beneficiary insured due to disability
  • 2: Beneficiary insured due to end stage renal disease (ESRD)
  • 3: Beneficiary insured due to disability and current ESRD

Acupuncture benefits reimbursement

Medicare will return acupuncture benefits when the appropriate acupuncture Service Type Code “64” is submitted in the request. Acupuncture benefits will include:

  • The number of technical sessions remaining and next technical date
  • Number of professional sessions remaining and next professional date

Pneumococcal vaccine (PPV) returns

Following the update, Medicare will return prior PPV service history for preventive service codes 90670 and 90732 if the Beneficiary has active Medicare Part B coverage. Previously, Medicare only returned PPV service history if the beneficiary had either Part A or Part B coverage.

Accessing the new codes and information will be easy for healthcare providers using ABILITY applications with integrated eligibility components. Our software – from ABILITY CHOICE All-Payer and ABILITY EASE All-Payer to ABILITY COMPLETE and ABILITY EASE MEDICARE – includes the latest changes to keep your facility operating efficiently and profitably. Learn more from ABILITY experts.


ABILITY and design®, ABILITY®, ABILITY CHOICE ®, ABILITY EASE ® and ABILITY COMPLETE® are trademarks of ABILITY Network, Inc.

Secure COVID-19 relief funds for your skilled nursing facility

Has your skilled nursing facility been diligent in tracking infection control and prevention during the COVID-19 pandemic? If so, your facility could be eligible for a portion of the $2 billion in relief funds being distributed by the U.S. Department of Health and Human Services (HHS). Additional details on how SNFs can receive incentive payments were recently released.

Eligibility for incentives

Previously, HHS announced that SNFs would be eligible for incentive payments based on how well they were able to control rates of COVID-19 infections, as well as COVID-19 mortality rates. HHS clarified the requirements last month, stating that facilities had to show that their rates of COVID-19 infections were lower than their counties’ rates of infection. The death rate among residents within the facility who tested positive for COVID-19 also had to be below a national performance threshold for mortality within nursing homes.

Those two measures serve as a “gateway” for participation in the incentive program. Each month, facilities must meet those two criteria to receive incentive payments. Eligible facilities will have their performances evaluated, with infection rates accounting for 80 percent of the incentive payment. Calculations will be made by dividing the facility’s number of non-admission COVID-19 infections by the total number of resident-weeks reported to the National Healthcare Safety Network (NHSN). The mortality rate will be calculated for any facility that reported at least one non-admission COVID-19 infection.

Tracking your facility’s incentive eligibility

How can you track your facility’s COVID-19 infections accurately to help qualify for relief funds? Many SNFs are turning to ABILITY INFECTIONWATCH to carefully track resident symptoms, infections and infection control measures. The application allows you to map infections within your facility and monitor data in real time to keep infection rates lower and maximize protection for residents and staff. ABILITY INFECTIONWATCH also helps administrators pull infection information and track the documentation required by NHSN.

Another application that can help SNFs qualify for COVID-19 incentives is ABILITY CAREWATCH. Facilities using ABILITY CAREWATCH to manage quality and QAPI incentives can more easily manage their Medicare and Medicaid licensing. Current licensing is required to receive incentive payments.

Staying up to date with infection reporting

COVID-19 incentive payments can help skilled nursing facilities like yours invest more in testing and PPE to keep residents and staff safe. Learn more about how ABILITY INFECTIONWATCH and ABILITY CAREWATCH can help your facility qualify for payments.



CMS audits have restarted: how skilled nursing facilities can prepare

The Centers for Medicare & Medicaid Services (CMS) resumed Recovery Audit Contractor (RAC) and Medicare Administrative Contractor (MAC) medical review audits in August.

Here’s what you need to know and how to prepare your skilled nursing facility in the event of an audit.

RACs and MACs are back

The ongoing COVID-19 public health emergency (PHE) brought considerable changes to healthcare facilities, including a temporary halt to most CMS audits on March 30, 2020. The suspension included prepayment and post-payment medical reviews conducted by MACs and RACs.

In July, CMS announced that it would be resuming medical review activities in August regardless of the status of the PHE. Audit activity ramped back up on August 17, prioritizing post-payment reviews of COVID claims submitted prior to March 1, 2020.

While CMS has not yet announced when the audits on claims submitted after March 1 will begin, they will likely commence in the coming months.

What you need to know

CMS has indicated that audits will be conducted in accordance with existing statutory and regulatory provisions, including related billing and coding requirements. However, any waivers or flexibilities that were allowed for any date of service under review will be applied in the audit.

Keep in mind that the rules changed rapidly at the onset of the PHE, which may increase the chances of audit errors as well as misapplication of rules and regulations.

If auditors are unable to make a determination on prepayment or post-payment claims review based on the information that’s been provided, they will issue an additional documentation request (ADR) to solicit supporting documentation.

While RAC and MAC audits historically have been done in person, CMS has expanded desk reviews during the pandemic. Although a remote audit may potentially be less burdensome on your organization, it will still be crucial to be organized and prepared.

Tips for audit response

CMS recognizes that many skilled nursing facilities have limited staffing and resources to respond to audits during this time. If your facility is selected for medical review, there are several actions you can take to facilitate the process.

  • Identify someone to manage the ADR and denial process
  • Promptly respond to every overpayment and audit letter (ADR)
  • Contact your auditor to discuss any COVID-19 related hardships you may be experiencing that could impact audit response timeliness
  • Avoid returning any overpayment before confirming and accepting the audit findings
  • Only send the specific information in the ADR to expedite the process
  • Make sure all documentation is legible and supports MDS coding and the UB-04

Boost audit success

Audits are disruptive even during the best of times. It’s more critical than ever to have an efficient and effective process in place to not only respond to an audit in a timely manner, but to also help you avoid one in the first place.

ABILITY CAREWATCH and ABILITY UBWATCH can help you get ahead of an audit request and potentially minimize the risk of an audit by ensuring accuracy between the MDS and UB-04. Data analytics and real-time reports give you access to:

  • Medicare roster
  • RUG 66 Watch page
  • Built-in Triple Check
  • Quality pages
  • And more!

There’s no time to waste! Get a first-hand view of how to use these applications to boost your audit response by requesting a demo today.



“Coronavirus waivers & flexibilities,” CMS, accessed October 9, 2020, https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers.

“MACs Resume Medical Review on a Post-Payment Basis,” MLN Connect eNews, CMS, August 6, 2020, https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-08-06-mlnc#_Toc47449031.

“CMS Announces Resumption of Routine Inspections of All Provider and Suppliers, Issues Updated Enforcement Guidance to States, and Posts Toolkit to Assist Nursing Homes,” CMS, August 17, 2020, https://www.cms.gov/newsroom/press-releases/cms-announces-resumption-routine-inspections-all-provider-and-suppliers-issues-updated-enforcement.


ABILITY and design®, ABILITY®, CAREWATCH® and UBWATCH® are trademarks of ABILITY Network, Inc.

How to prepare for the impact of MDS 3.0 for FY 2021

The Centers for Medicare & Medicaid Services (CMS) was set to release the Minimum Data Set (MDS) 3.0 version 1.18.1 on October 1, 2020. However, the COVID-19 public health emergency upended that plan.

Prior to the pandemic, CMS intended to eliminate Section G along with making some changes to other sections of the MDS. Then in March, as part of the blanket 1135 waiver, the regulatory agency delayed the release of the planned version of the MDS to give skilled nursing facilities more flexibility in their response to COVID-19.

With a new scaled-down MDS 3.0 going into effect on October 1, it’s crucial for facilities to understand the impact of the changes and take the necessary steps to manage Medicaid revenue for FY 2021.

Understanding the impact

The interim MDS 3.0 version 1.17.2 is designed to facilitate the calculation of Patient Driven Payment Model (PDPM) payments on all Omnibus Budget Reconciliation Act (OBRA) assessments.

Each state has the option of requiring PDPM data on OBRA comprehensive and quarterly assessments. New item sets include section GG, item I0020B ICD-10 for the primary medical condition and J2100 recent surgery requiring active SNF care.

The key takeaway here is knowing where your state has landed regarding the collection of PDPM data on the OBRA assessments, and if you will be required to complete an Optional State Assessment (OSA).

Tips for success

First and foremost, there’s no need to panic. While your state may require PDPM data beginning October 1, your payments on that data will not be affected. Keep in mind that the purpose of these changes is to inform future Medicaid models.

Here are several steps your facility can take to adapt to the new MDS for FY 2021:

  • Contact the RAI Coordinator for your state to find out the new requirements
  • Educate your team on how to accurately code for the new section and items on MDS version 1.17.2
  • Make sure your Electronic Health Record (EHR) is updated to align with the October 1 changes
  • Implement a robust process for collecting PDPM data across all payers

How ABILITY can help

ABILITY CAREWATCH equips you with software tools that will enable your facility to be ready for any quality management changes coming its way. With updated logics, you can create real-time reports to closely monitor quality and revenue and comply with state and federal requirements.

Specific to MDS 3.0, you’ll have access to:

  • An MDS Detail Report and ADL Report to improve data accuracy on Sections GG and J
  • Diagnosis Watch and PDPM tools to help manage Section I and boost reimbursement
  • Restorative Watch to improve resident outcomes via a robust restorative nursing program

Discover firsthand how to put this application to work for your facility by requesting a demo today.


“MDS 3.0 Technical Information,” CMS, accessed September 21, 2020, https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30TechnicalInformation

ABILITY and design®, ABILITY® and CAREWATCH® are trademarks of ABILITY Network, Inc.

Avoid postal delays with paperless claims and statements

The U.S. Postal Service is experiencing delays in mail delivery across the country. At the same time, Americans everywhere – especially vulnerable populations, such as elderly people and those living with comorbidities – are being asked to stay home. As a result, many of your patients have very real anxiety over when (or whether) they’ll receive their medications.

According to a recent article from NPR, “Nationally, an Ipsos poll found that 1 in 5 Americans got medication through the mail in the past week, and 1 in 4 of them experienced a delay or nondelivery.”1 And patients aren’t the only ones impacted by lagging deliveries. Commercial and private mail services have been affected, creating concerns for small and medium-sized businesses that rely on mail delivery services.2

If your organization relies on paper claims submissions and patient statements, you could be facing longer A/R days and more work resubmitting lost claims. Likewise, with delivery delays, paper statements and bills may not reach patients in a timely manner, making it more difficult to capture patient payments.

Postmaster General Louis DeJoy has told the U.S. Senate that the Postal Service will not implement any changes in service until after the election.1 This could mean that more delays are on the horizon. Even if you have not yet experienced issues with lost or late mail, upcoming changes to U.S. Postal Service delivery programs may lead to more delivery issues in the coming months.

So, what can you do? Instead of bracing yourself for longer days in A/R, why not take advantage of this time to go paperless? With the right technology, you can:

  • Give patients the option to receive their statements online via email
  • Electronically upload claims attachments
  • Submit claims online instead of by mail

Want to learn more about applications that can help you accelerate A/R and avoid postal delays? Read about ABILITY CHOICE All-Payer Claims and ABILITY EASE All-Payer, or request a demo today.



  1. “Postal Service Slowdowns Cause Dangerous Delays In Medication Delivery,” Paige Pfleger, NPR, August 25, 2020. Accessed September 10, 2020, https://www.npr.org/sections/health-shots/2020/08/25/905666119/postal-service-slowdowns-cause-dangerous-delays-in-medication-delivery
  2. “Are postal service delays hampering small business?” KTTN News, August 13, 2020. Accessed September 10, 2020, https://www.kttn.com/are-postal-service-delays-hampering-small-business/

ABILITY and design®, ABILITY®, CHOICE® and ABILITY EASE® are trademarks of ABILITY Network, Inc.

The PBJ reporting waiver has ended: what you need to know

In a memorandum released on June 25, CMS announced the end of the COVID-19 emergency waiver for staffing data submissions.

Back in March, CMS had granted a series of blanket waivers to lessen administrative burden and allow nursing homes to focus on responding to the COVID-19 threat. Facilities now must resume submission of their staffing data through the payroll-based journal (PBJ) system as required by regulation.

Why it matters

A recent study published in the Journal of the American Geriatrics Society found that facilities with lower nurse staffing levels and lower scores on the Five-Star Quality Rating System before the pandemic had higher rates of COVID-19 infections and deaths. In fact, higher nurse staffing ratios were strongly correlated with fewer cases and deaths.

The authors of the study recommended that nursing home inspections should target facilities with lower RN staffing levels and quality ratings in addition to those located in areas with high infection rates.

On the heels of these findings, CMS made the announcement that nursing homes must recommence submission of their staffing data, stating that “we continue to emphasize the importance of staffing based on its relationship to quality.”

What this means for your facility

Here’s what you need to know about PBJ data submissions for 2020:

  • Staffing data for April-June is due by the usual deadline of August 14
  • You are not required to submit your staffing data for January-March
  • Nursing Home Compare is displaying the staffing star rating based on your October-December 2019 data
  • New Five-Star staffing ratings, based on your April-June data, will post at the end of October 2020
  • Facilities that received an automatic staffing downgrade to one star for the fourth quarter of 2019 will have their measures and rating temporarily suppressed and that one-star staffing rating downgrade removed

How ABILITY can help

While CMS is giving long-term care providers the opportunity to correct and improve their star rating, the agency plans to restart inspections “as soon as possible.” To protect your star ratings and ensure compliance with the PBJ reporting requirements, it is crucial to act soon. This is where ABILITY can help.

ABILITY CAREWATCH PBJ puts the right tools at your fingertips so you can efficiently collect, classify, validate and submit your facility’s direct care staffing data accurately and on-time.

To see firsthand how easy PBJ reporting can be, request a demo today.


ABILITY and design®, ABILITY® and CAREWATCH® are trademarks of ABILITY Network, Inc.