Conference Meeting CMS Presentation CLA Slide

SNFs and nursing homes should understand PBJ requirements because they will seriously impact how organizations report data to CMS.

Navigating health reform

CMS’ Payroll Based Journal Impacts the SNF Provider Community

  • Deb Emerson
  • Richard Hamilton
  • 4/29/2016

Updated 6/21/2016 to address recent CMS updates.

Section 6106 of the Affordable Care Act requires skilled nursing facilities (SNFs) and nursing facilities (NFs) to electronically submit direct care staffing information for facility and contract staff based on payroll data and other auditable data. This data, along with quarterly census data, and employee/contracted staff information will be utilized in the future by the Centers for Medicare and Medicaid Services (CMS) as part of the Five-Star Quality Rating System calculations.

The final rule for payroll based journal (PBJ) requirements for SNFs and NFs was published August 4, 2015, by the CMS. SNFs and nursing homes need to understand these requirements because they seriously impact how organizations report data to CMS. Because the information is linked to quality ratings, requirements may also impact how consumers view their facilities.

Issues that will affect organizations 

The following is a breakdown of what organizations will need to do to adhere to PBJ requirements: 

  • Providers must register with the CMS Quality Improvement and Evaluation System (QIES) to submit data. In order to connect to PBJ through QIES, you must have a CMSnet user ID; this is the same system used for minimum data set (MDS) submissions.
  • Methods of data submission:
    • Manually entered by facility personnel
    • Uploaded directly from an automated payroll or time and attendance system, or third party vendor, and submitted in XML format
    • Combination of manual and upload data
  • Staffing and census will be collected quarterly with a filing deadline of 45 calendar days after the last day of each fiscal quarter (e.g., the July 1 – September 30 submission deadline is November 14, 2016).
  • All data submitted must be timely and accurate using reasonable allocation methodology. CMS has the right to audit the data submitted.
  • All data submitted will be subject to enforcement actions for noncompliance. Each facility employee and contract employee must be assigned to one of the 40 labor category codes and job titles codes, and include hire date, termination date, and hours worked. Excluded hours include the following:
    • Hours not worked but paid (e.g., paid time off, sick time, FMLA)
    • In-service or training hours
    • Hours for services performed that are billable to Medicare fee-for-service
    • Staff hours (both facility and contract) for services provided to non-NF residents or services such as assisted living, independent living, home health/hospice, private duty, and adult day care
    • Outpatient rehabilitation for non-SNF/NF residents

Allocating service costs and hours 

Based on the PBJ FAQs, CMS has expressed that “facilities must use a reasonable methodology for calculating and reporting the number of hours spent on site conducting primary responsibilities, based on payments made for these services. Hours for services that are billed to Medicare fee-for-service reimbursement or other payer sources should not be reported.”

CMS recently made several clarifications to the PBJ manual (version 2.1), including that hours for physical, occupational, and speech therapy services paid under both Medicare Part A and Part B should be reported. Additional CMS clarification will need to be provided as the reporting process evolves. CMS has also stated that the PBJ data will be used to calculate information related to a provider’s Five-Star Quality Rating. This will impact Nursing Home Compare information and staffing domain thresholds, and eventually eliminate the data reported on CMS Form 671.

If facilities are not compliant with PBJ requirements, they will be subject to enforcement actions, which have not yet been disclosed.

Take proactive steps 

  • Review the latest CMS PBJ Manual version 2.1 dated April 2016.
  • Obtain CMSNet Portal Access.
  • Obtain PBJ Submission Access.
  • Sign in to CMSnet user system, QIES, and monitor the PBJ CMS website for changes.
  • Submit practice data sets and test prior to July 1, 2016.
  • Review and update your contracts after meeting with your contracted service providers to expand their responsibilities and clarify expectations to enhance PBJ reporting compliance.
  • Work with your contracted service providers to establish electronic files in the required format on a reasonable timeframe for upload to CMS. (After each payroll or monthly may be better than quarterly to allow time to resolve errors.) Meet with your payroll and/or time and attendance software vendor(s) to assess the options they are offering for PBJ compliance.
  • Update policies and procedures for PBJ purposes, and update personnel forms to include PBJ required fields, as well as labor codes and descriptions. This is an opportunity to update your job descriptions, particularly for staff with multiple functions, consistent with PBJ reporting.
  • Discuss labor time/plan budget and assign ongoing personnel who will monitor PBJ compliance. Consider outsourcing options.

How we can help 

Although CMS still has many issues to address in this endeavor, your facility should allocate appropriate time to this regulatory requirement to make this transition as seamless as possible.

CLA professionals can assist throughout this process by helping you:

  • Obtain a QIES log in
  • Obtain registration for PBJ
  • Review labor categories your organization currently has established for direct care staff
  • Establish a unique ID for every facility and contracted employee
  • Review your facility’s direct care staff in accordance with the established CMS job title code
  • Examine/document the organization’s PBJ reporting systems for compliance and auditability
  • Collaborate with your facility to provide reporting assistance as it pertains to all PBJ submission requirements
  • Evaluate outsourced solution to assist your organization with this regulatory requirement