Changes and Results from First PBJ Submission

Mar 30, 2017 | Rules for PBJ Reporting, Five Star Staffing Ratings

News Digest: Changes and Results After First PBJ Submission

With the first full PBJ reporting period over, and 90%+ facilities successfully submitting a PBJ report – CMS identified data and technical issues to clean up.  Those changes came through in a new Policy Manual and FAQ.  Meanwhile the industry found some areas of PBJ reporting that could merit a change.

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CMS urges more provider diligence on PBJ data

Skilled nursing providers should submit their next round of payroll based journaling data well ahead of the May 15 deadline in order to catch errors, Centers for Medicare & Medicaid Services officials said Thursday.

CMS staff told attendees of the Skilled Nursing Facility Open Door Forum call to not hold out until the deadline in order to see if there are “errors and issues” and leave time for corrections if needed.

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Mongan, Emily. “CMS Urges More Provider Diligence on PBJ Data; Notes Nursing Home Compare Update.” McKnight’s Long-Term Care News, 24 Mar. 2017, www.mcknights.com/news/cms-urges-more-provider-diligence-on-pbj-data-notes-nursing-home-compare-update

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Providers get an ‘A’ for submitting PBJ data, officials say

Around 90% of long-term care providers have submitted electronic staffing data, officials said Thursday.

The Payroll-Based Journal submissions were due Nov. 14 to reflect staffing data from July 1 to Sept. 30. However, the Centers for Medicare & Medicaid Services will accept submissions until Dec. 1 as long as providers are making a “good faith effort,” according to sources on a CMS Skilled Nursing Facilities/Long-Term Care Open Door Forum call Thursday.

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Newman, Elizabeth Leis. “Providers Get an ‘A’ for Submitting PBJ Data, Officials Say.” McKnight’s Long-Term Care News, 18 Nov. 2016, www.mcknights.com/news/providers-get-an-a-for-submitting-pbj-data-officials-say

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PBJ updates make it easier for providers to submit hire, termination, and rehire information

On February 17, 2017, the Centers for Medicare & Medicaid Services (CMS) released two updates to the Payroll-Based Journal, making it easier for providers to submit hire, termination, and rehire information for employees without receiving errors.

These updates, detailed below, are considered a “step in the right direction” by the American Health Care Association (AHCA) in their pursuit, joined by other providers and organizations, to “create efficiencies in the collection of staffing data.”

Hurlburt, Amanda. “PBJ Updates Make It Easier for Providers to Submit Hire, Termination, and Rehire Information.” The Post-Acute Advisor, 23 Feb. 2017. No longer available.

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Don’t punish SNFs for training

The Centers for Medicare & Medicaid Services have made information technology and staff competency a priority for the past five years. In response, skilled nursing facility educators expanded training programs to keep up with increased needs. For example, a Certified Nursing Assistant early detection training program was focused on decreasing re-hospitalizations.

Then in July 2016, the Payroll Based Journal system became mandated. It requires a SNF to deduct the hours CNAs participate in in-service training so that staffing levels will be accurately reflected for the Nursing Compare Five Star Rating reporting. Consequently, SNFs are be penalized for training their staff. That’s despite saving the CMS money by avoiding unnecessary hospital readmissions and improving quality of care.

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Marcus, Jeff R. “Don’t Punish SNFs for Training.” McKnight’s Long-Term Care News, 30 Dec. 2016, www.mcknights.com/blogs/guest-columns/dont-punish-snfs-for-training

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CMS Staff Tracking System Promises More Accuracy

The new payroll-based journal (PBJ) system developed by the Centers for Medicare & Medicaid Services to determine the staffing component ratings in the Five-Star Quality Rating System will likely be “a huge change, [resulting in] a more comprehensive and more accurate” look at a facility’s staffing, Ashkan Javaheri, MD, CMD, said at the AMDA – the Society for Post-Acute and Long-Term Care Annual Conference.

Medical directors’ hours are part and parcel of the new system, and “it’s important to understand that the hours you [record and] submit should be based on your medical directorship duties — on what the facility is paying you to do,” said Dr. Javaheri, assistant professor at the University of California–Davis School of Medicine and head of the geriatric division at Mercy Medical Group–Dignity Health Medical Foundation in Sacramento. “Hours for your patient care are not reportable in PBJ.”

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Kilgore, Christine. “CMS Staff Tracking System Promises More Accuracy.” Caring for the Ages, 1 June 2017, www.caringfortheages.com/article/S1526-4114(17)30196-8/fulltext#relatedArticles

Related CMS and PBJ Resources

To learn more about the details, policies and information in these articles, please review these CMS and PBJ publications.

CMS QSO memorandum for PBJ
QSO Memo 17-25-NH
Payroll Based Journal Policy Manual
PBJ Policy Manual v2.2
FAQs for PBJ Policy Manual
PBJ Policy FAQs Dec '16

More News in this PBJ Topic

CMS Updates Staffing & Turnover Measures

the Centers for Medicare & Medicaid Services (CMS) issued updates to guidance on minimum health and safety standards that Long-Term Care (LTC) facilities (often called “nursing homes”) must meet to participate in Medicare and Medicaid.

CMS also updated and developed new guidance in the State Operations Manual (SOM) to address issues that significantly affect residents of LTC facilities.

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Ask the payment expert …. about the total nurse staffing measure

Q: What is the Skilled Nursing Facility Value-Based Payment Total Nurse Staffing Measure?
A: The Total Nursing Hours Per Resident Day Measure uses auditable electronic data reported to the Payroll-Based Journal system to calculate total nursing hours per resident day. It is one of two new measures that will begin affecting payments in the FY 2026 SNF VBP program year, the other being SNF Healthcare Associated Infections Requiring Hospitalization.

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States get needed nurse aide waiver relief but workers’ fates uncertain

Skilled nursing providers in at least 15 states averted the loss of thousands of frontline workers Thursday, when the Centers for Medicare & Medicaid Services let expire a blanket national waiver allowing the use of non-certified nurse aides. Those states had been awarded new waivers through an application process, meaning they demonstrated testing backlogs or other delays that kept providers from converting a large share of temporary nurse aides into permanent certified nurse assistants.

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Thousands of nursing homes face lower Five-Star ratings

New Five-Star scoring metrics could penalize an estimated 10% to 16% of providers who have relied on staffing strengths to drive their overall ratings.

The Centers for Medicare & Medicaid Services on Thursday published new guidance for calculating staffing stars in the public-facing rating system. It incorporates total nurse staffing on weekends; annual RN and total nurse turnover; and administrator turnover.

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CMS offers leniency to Kronos users impacted by ransomware attack

Ultimate Kronos Group (UKG), a software used by SNFs for PBJ submission, was the victim of a ransomware attack on December 11, 2021. CMS announced it will not downgrade affected facilities that miss the February 14, 2022 PBJ submission deadline or submit incomplete information.

Impacted Kronos users need to contact CMS by March 1, 2022 with specific requested information as noted in the CMS memo below.

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How to Boost Your Nursing Home Star Rating

For the administrator looking to improve an overall quality score quickly, the staffing score is a good place to start.

The staffing score will boost a facility’s overall score by one star if it: exceeds the health inspection score, and is either four or five stars.

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Importance of the human touch

Everyone falls into auto-mode now and then. While SimplePBJ continues to discover and add new verification checks for potential issues, the human touch is still needed to confirm the PBJ data you’re submitting is accurate.

Don’t get lulled into thinking the data from your payroll or timekeeping system is 100% PBJ ready. Many times that ends up not being the case.

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Staffing Rating Under 4 Stars? Review PBJ Data; Set and Monitor Goals

Staffing is difficult—that was a defining truth for nursing homes before the COVID-19 public health emergency created a full-blown staffing crisis that still is harming providers throughout healthcare. So, it may seem like the wrong time for directors of nursing services (DNSs) to pay much attention to the staffing domain in the Five-Star Quality Rating System.

“However, all of the Five-Star data—the staffing, health inspections, and quality measures domains—funnels into multiple parts of a facility’s life,” says Shelly Maffia, RN, MSN, MBA, NHA, QCP, CHC, director of regulatory services for Proactive Medical Review and Consulting in Evansville, IN.

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5 Star, QMs, and PBJ Data Updates

5 Star, QM’s and PBJ data updates have been released. Last week, we shared that QRP’s were released for review. All are critical reporting which impacts our 2022 FY reimbursement and our publicly displayed information on Care Compare. There are a few small windows of time for review and correction if needed.

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