Are You in Compliance with PBJ Reporting?

In April 2018, CMS began using the PBJ data to calculate staffing measures which will be posted on Nursing Home Compare and used in the Five Star Quality System. Staffing measures and staffing star ratings were calculated based on the data for the 2017 Calendar Quarter 4 that was submitted prior to the February 14, 2018 deadline.

Nursing homes whose data identifies significant inaccuracies between the hours reported and the hours verified, or facilities who fail to submit any data by the required deadline will be presumed to have low levels of staff. This will result in a one-star rating in the staffing domain which will lower their overall (composite) star rating by one star for a quarter.

Facility Census Data

Facility census data will be determined from submitted MDS assessments each quarter. The admission and discharge MDS must be transmitted and accepted into the QIES ASAP system for census calculation. Each facility’s staffing measure, reported as hours per resident per day (HPRPD), is adjusted based on the expected level of staff needed based on the distribution of residents by Resource Utilization Groups.

CMS will continue to calculate the staffing rating by combining a total nurse staffing rating (registered nurse (RN), licensed practical nurse, and nurse aide) with an RN rating, but remember, PBJ groups only RNs in the RN job categories and does not include LPNs with administrative duties. As a result, facilities may experience a decrease in RN hours under the new methodology.

Read the full CMS Memorandum here.

Ensuring Accurate Data Submission

Exclude Time for Meal Breaks

Each Employee Must Have Their Own Unique Identifier (ID)

Adhere to Minimum Data Set (MDS) Assessment Completion &Transmission Requirements

Exclude Hours for Staff that Provide Care to Individuals in Non-certified Areas of a Larger Institution

Respond Promptly to the Audit Contractor if Contacted for an Audit

Proactive Medical Review is Here to Help.

Contact Proactive today for assistance with MDS accuracy, Data Integrity audits, and driving your facility Five-Star Quality rating.

Contact us today!

Eleisha Wilkes, RN, RAC-CT

Eleisha Wilkes is a Registered Nurse with over fifteen years

of experience in long term care. She has served as a Director of Nursing, Case Manager and Resident Assessment Coordinator with extensive responsibility and success in driving QA in the areas of person centered assessment and care planning through effective systems, staff development, and interdisciplinary team collaboration. She now serves as an RN Clinical Consultant with Proactive Medical Review & Consulting, LLC.