Key Links

Here is a list of our favorite links. We hope this list helps you LOCATE / RESEARCH your topic of interest. If you have suggestions about other sites to include, send email to info@proedcontinuum.org.

• QAPI Links
• MDS Links
• SNF PSS Links
• SNF PPS Consolidated Billing Links
• Therapy Links
• CMS Statistical Links
• Survey Certification Links
• BNI Links
• Online Manual System Links
• ICD-10 Links
• Home Health Links
• Hospice Links

QAPI (Quality Assurance / Process Improvement) Links

• QAPI Description and Background
• Quality Assurance and Performance Improvement (QAPI) program (basic information and future home of prototype tools)
• QAPI TOOLS
  • QAPI Self-Assessment Tool
  • Guide for Developing Purpose, Guiding Principles, and Scope for QAPI
  • Guide for Developing a QAPI Plan
  • Goal Setting Worksheet
• QAPI Resources
  • Goal Setting Worksheet
  • QAPI at a Glance-
  • Quality Improvement Organizations
  • Advancing Excellence in America’s Nursing Homes
  • Agency for Healthcare Research and Quality.
  • Department of Veterans Affairs
  • Getting Better All the Time: Working Together for Continuous Improvement
  • Implementing Change in Long-Term Care: A Practical Guide to Transformation
  • Interact II
  • Model for Improvement.
  • Picker Institute Publications
• Stakeholder Engagement
  • Stakeholder Engagement Timeline

MDS Links

• MDS 3.0 Manual & Updates
  • Official Home the RAI Manual
  • MDS 3.0 Spotlight page
  • MDS 3.0 Training page
  • MDS 3.0 Quality Measures
  • MDS 3.0 Quality Measures M User’s Manual
  • MDS 3.0 Technical Information
  • MDS 3.0 Submission Specs V1.14.0 for the October 1, 2014 Release [ZIP, 10MB]
  • MDS 3.0 Item Subsets V1.12.0 for the October 1, 2014 Release [ZIP, 8MB]
  • MDS 3.0 Submission Specs Errata V1.14.0 for the October 1, 2014 Release [ZIP, 10KB]

SNF PSS Links

• SNF Provider Center
  • General Information & Provider Resources
  • SNF Federal Regulations
  • SNF Program Transmittals
  • SNF PPS Overview/Index
  • SNF PPS Spotlight page (News and RUG-IV data)
  • FY2012 RUG-IV SNF PPS Education and Training
  • Nursing Home Quality Initiative Overview/Index page
  • March 2012 MDS 3.0 National Conference Downloads
  • SNF/LTC Open Door Forum page
  • Forms (access current CMS forms, such as CMS-802, Roster/Sample Matrix, and CMS-802P, Roster/Sample Matrix Provider Instructions)
  • Medicare Coverage Database
• SNF PPS Consolidated Billing
  • SNF Consolidated Billing Overview page 
  • 2013 FI / A/B MAC HCPCs Exclusions / Inclusions (CMS Updates Qrtly. or as needed)
  • 2013 Carrier Update file (a set of HCPCS exclusions/inclusions code files for outside providers/vendors, e.g., physicians, ambulance providers, etc.)
  • SNF Consolidated Billing transmittals 
  • Consolidated Billing  - Ambulance Services – MLN Matters SE0433 Revised (12/13)

CMS Statistical Links

• SNF PEPPER Released by CMS:
  (Helps With Internal Medicare Audits (8/13) – TMF Health Quality Institute)
  • National SNF Q4FY12 Report
  • Skilled Nursing Facilities Training Sessions
• SNF Monitoring 
  • 508 Compliant version of RUG Days FY11 FY12 Quarter 3 urban rural (Excel file)
  • 508 Compliant version of RUG Days FY11 FY12 Quarter 3 urban rural(PDF file)
  • Wage Index page (wage indexes for each fiscal year)
  • SNF PPS PC Pricer
  • Recovery Audit Program Overview / Index page
  • Official Nursing Home Compare Data (12/2013)

Therapy Links

• Fee Schedules
  • CY 2013 Physician Fee Schedule Final Rule
  • Physician Fee Schedule Search Tool
  • Therapy HCPC /CPT Code List & Dispositions
  • 2014 Therapy Code List & Dispositions
  • 2014 Physician Fee Schedule
• New CMS Rules on Manual Medical Reviews in Outpatient Therapy
  • CMS Therapy Cap Web page
  • 2013 Part B Therapy Cap Fact Sheet (1/13)
  • Therapy Services Index page (Launch page for information about Part B caps and where to find info about exceptions process)
  • 2014 Therapy Caps and SGR reform act of 2013
• Part B Therapy Functional Reporting: New Reporting Rules Impact Billers & Therapists - UPDATED (1/13)
  • Preparing for Therapy Required Functional Reporting Implementation in CY 2013 (NEW)
  • Therapy Functional Reporting G-codes – Short Descriptors (NEW)
  • NEW products from the Medicare Learning Network® (MLN) (NEW)
  • CMS Manual System - Pub 100-02 Medicare Benefit Policy (NEW)
  • CMS Manual System - Pub 100-04 Medicare Claims Processing (NEW)

Survey Certification Links

• Nursing Home Survey and Certification (where CMS maintains the Special Focus Facility List)
  • CMS Nursing Home Survey and Certification Main Page
  • Five Star Quality Rating System (documentation, including regularly updated state-level cut-point tables and staff time values sets)
  • Survey-and-certification memos

BNI Links

• Beneficiary Notices Initiative (BNI)
  • CMS BNI Main Page
  • FFS Expedited Determination Notices page (forms CMS-10123 and CMS-10124 for Medicare Part A, Medicare Part B, and Medicare Advantage. Effective May 1, 2012, new combined forms will be used for residents covered by all three payers)
  • Medicare Advantage Expedited Determination Notices page (forms CMS-10123 and CMS-10124 – new forms required effective May 1, 2012. See above)
  • Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN) and Medicare denial letters
  • Revised ABN (form CMS-R-131, used in SNFs only for items/services expected to be denied under Medicare Part B)
  • FFS NEMB SNF (form CMS-20014, voluntary use only)
  • Advance Beneficiary Notice of Non-coverage Frequently Asked Questions Document Now Available

Online Manual System Links

• CMS Internet Only Manual System (Launch page for all CMS online manuals)
  • http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html
• State Operations Manual (SOM; pub 100-07)
  • http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS1201984.html
• Chapter 7, Survey and Enforcement Process for Skilled Nursing Facilities and Nursing Facilities / SOM
  • http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/som107c07.pdf
• State Operations Manual
  • Medicare State Operations Manual Appendix
  • Appendix P, Survey Protocol for LTC Facilities / SOM
  • Appendix PP, Guidance to Surveyors for LTC Facilities / SOM
  • Appendix Q, Guidelines for Determining Immediate Jeopardy / SOM
• Internet-Only Manuals (IOMs)
  • Medicare Benefit Policy Manual (BPM; pub 100-02)
  • Medicare Claims Processing Manual (CPM; pub 100-04)
  • Chapter 5, Part B Outpatient Rehabilitation and CORF/OPT Services / Medicare Claims Processing Manual (Information about Part B therapy multiple procedure payment reductions and therapy cap exceptions)
  • Chapter 6, SNF Inpatient Part A and SNF Consolidated Billing / Medicare Claims Processing Manual
  • Chapter 7, SNF Part B Billing (Including Inpatient Part B and Outpatient Fee Schedule) /Medicare Claims Processing Manual
  • Chapter 8, Coverage of Extended Care (SNF) Services / Medicare Benefit Policy Manual (how to meet a Part A SNF skilled level of care, fulfill the requirement for a qualifying three-day hospital stay, and other key information)
  • Chapter 15, Covered Medical and Other Health Services / Medicare Benefit Policy Manual (includes coverage and documentation requirements for Part B therapy services)
  • Chapter 16, General Exclusions from Coverage / Medicare Benefit Policy Manual
• Transmittals Index page (Launch pad for transmittals, or change requests, issued in the current calendar year, as well as previous years dating back to 2000. CMS uses transmittals to update the online manuals, as well as to provide instructions to Medicare contractors)
  • http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/index.html

ICD-10 Links

• ICD-10 Overview / Index
  • http://www.cms.hhs.gov/Medicare/Coding/ICD10/index.html
  • www.ama-assn.org/go/ICD-10
  • http://www.ahima.org/icd10/
• ICD-10 Provider Resources
  • ICD10 Latest news
  • ICD10 Provider Resources
  • ICD-10 Implementation Timelines
  • ICD-10 Pilot Program - NPP Fact Sheet
  • AHIMA ICD-10-CM/PCS Organizational Readiness Assessment and Prioritization Tool

• ICD10 Testing
  • Pilot End-to-End Testing of Compliance with Administrative Simplification
• 2014 ICD-10-CM and General Equivalency Mapping (GEMs)
  • 2014 ICD-10-CM and GEMs
• ICD10 Related Links
  • Wisconsin ICD10 Readiness Partnership (WICD10)
  • American Health Information Management Association (AHIMA)
  • American Medical Association (AMA)
  • Blue Cross Blue Shield Association (BCBSA)
  • Workgroup for Electronic Data Interchange (WEDI)

Home Health Links

• HHA Spotlights
  • CMS Home Health Agency Center
  • Home Health Face-to-Face Encounter Question & Answers (03/01/13)
  • Therapy Questions and Answers (03/01/13)
• HHA Survey & Certification Compliance
  • CMS Survey & Certification - Certification & Compliance
• HHA Billing / Payment
  • Home Health PPS
  • Coding and Billing Information
  • Home Health Prospective Payment System (HH PPS) PC Pricer
  • CY 2011 Home Health PPS Wage Index File [ZIP, 32KB]
  • Home Health Case Mix Grouper Software Package
• HHA Policies/Regulations
  • Home Health Prospective Payment System Regulations and Notices
    Quarterly Provider Updates
• HHA Initiatives
  • Home Health Quality Initiative
  • Home Health Compare
  • Beneficiary Notices Initiative (BNI)
  • FFS HHABN
  • FFS ED Notices
• HHA Outcome and Assessment Information Set (OASIS)
  • Outcome and Assessment Information Set (OASIS)
  • OASIS User Manuals
  • OASIS - (Attachment D: Selection & Assignment of OASIS Diagnosis) Guidance

Hospice Links

• Contact us for details about all of the consulting services we have to offer

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