Embedded Files
Out-of-Compliance with SNF QRP Requirements Notification
Out-of-Compliance with SNF QRP Requirements Notification
CMS is providing notifications to Skilled Nursing Facilities (SNFs) and non-critical Access Hospital (CAH) Swing Beds (SBs) that were determined to be out of compliance with SNF Quality Reporting Program (QRP) requirements for calendar year (CY) 2023 which will affect their fiscal year (FY) 2025 Annual Payment Update (APU). The notifications were distributed on July 3, 2024, by the Medicare Administrative Contractors (MACs) and placed into facilities' 'My Reports' folders in iQIES. If you received a letter/notice of non-compliance you may submit a request for reconsideration to CMS via email, no later than 11:59 pm, August 14, 2024, following the instructions in your notification letter and on the SNF Quality Reporting Reconsideration and Exception & Extension webpage.
Please note: Any reconsideration containing protected health information (PHI) will not be processed. All PHI must be removed for a reconsideration to be reviewed.
This Change Request (CR) will implement an update to a current claims processing edit to allow for the subsequent claim submission containing the same admission date when the prior claim was processed as a no-pay claim.
II. EFFECTIVE DATE: January 1, 2025 *Unless otherwise specified, the effective date is the date of service.
III. IMPLEMENTATION DATE: January 6, 2025
Background: The purpose of this Change Request (CR) is to delete a current claims processing edit. This CR applies to the Fiscal Intermediary Shared System (FISS). PDPM claims submitted by a Skilled Nursing Facility (SNF) on Type of Bill (TOB) 21X and swing bed providers on TOB 18X, (subject to SNF PPS) are subject to these requirements. This will allow for subsequent claims to be processed correctly after the initial claim was rejected.
Policy: No policy changes exist with this CR.
CMS is offering this web-based training course providing an overview of key updates to the post-acute care (PAC) Quality Reporting Programs (QRPs) for Fiscal Year (FY)/Calendar Year (CY) 2025. The training discusses new, removed, and revised quality measures (QMs). Timelines for public reporting and an overview of measure specifications are provided.
Page updated
Report abuse