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medicare part a
Toolbox Content
- Medicare Part A Rules :
- SNF | SNF Explanation of Content
- PDPM Tools, Calculators and Custom Content
- Most Current SNF PPS Proposed and Final Rules, including:
- Fact Sheet
- CMS Wage Index Home Page
- CMS Wage Index Tables
- PDPM Changes
- Prior Year SNF PPS Proposed and Final Rules
- Medicare Program Integrity Manual – Chapter 6 PDPM Updates
- For all PDPM content go to PDPM Resource Center
- PPS MDS and Payment Schedule
- Advanced Beneficiary Notices
- Breakdown of Requirements for each form
- Appeals Process – CMS
- What is Skilled Therapy Fact Sheet
- SNF Billing Fact/Reference Sheet
- SNF Part A Certification and Recertification Requirements (for SNF stay)
- SNF Part A Nursing Documentation to Support Skilled Care
- Part 1
- Part 2
- Therapy Schedule and Minute Tracker (sample)
- PPS 100 Day Tracker Sample 1 | Sample 2
- MDS Therapy Data Sheet
- Statistics and Report Forms
- ICD-10-CM Code List: LTC Therapy Most Common Codes
- CPT Codes for PT, OT and Speech
- Sample Billing Logs for PT, OT, Speech
- Medicare Part A Weekly Meeting Template
- Med A Triple Check Worksheet
- Therapy Discharge Notice (3 Day Notice to Nursing)
- Beneficiary Notice Cheat Sheet – NOMNC, ABN
medicare part b
Toolbox Content
- Medicare Part B Rules (SNF, Hospital Outpatient)
- Part B Explanation of Content
- Evaluations | Progress Reports | Daily Treatment Encounter Note
- Re-Certifications | Discharge Reports
- CMS Therapy Documentation Fact Sheet
- Part B Explanation of Content
- Modifiers
- KX Modifier Threshold and Manual Medical Review
- MLN Matters 12397 – CO CQ Modifiers
- CO / CQ Therapy Assistant Modifier – Decision Tree (1/1/22)
- Proper use of Modifier 59
- NCCI Edits [National Correct Coding Initiative]
- Medicare Part B Edits for SNF, CORF, OPT
- Medicare Part B Edits for Private Practice
- CMS NGS Link To All LCD’s
- PT and OT Outpatient Revised LCD
- PT and OT Coding and Billing LCD Updates
- Speech LCD Updates
- PT and OT Outpatient Revised LCD
- Physician Fee Schedule
- CMS Physician Fee Schedule Home Page
- 2023 (CY2023) Physician Fee Schedule Final Rule
- Federal Register Link
- PDF Link
- CMS Home Page Link
- Archived Rules
- 2022 to 2014 Final Rules
- Physician Fee Schedule LOOK UP TOOL
- SNF CPT Coding PT OT SLP- With AMA Definitions and Coding
- Advanced Beneficiary Notice Forms CMS-R-131
- When to use and not to use
- Statistics and Report Forms
- CPT Therapy Evaluation Codes
- PT and OT Decision Chart for CPT Evaluation Codes by Complexity
- PT Decision Chart and Documentation Tool – Eval Codes by Complexity
- OT Decision Chart and Documentation Tool- Eval Codes by Complexity
- Med B Triple Check Worksheet
- Beneficiary Notice Cheat Sheet – NOMNC, ABN
- New/Modifications to the Place of Service (POS) Codes for Telehealth
- Appeals Process
MDS 3.0 Tools and Resources
Toolbox Content
mDS 3.0
Current RAI manual & mDS Item Sets
- CMS MDS HOME PAGE FOR UPDATES
- MDS 3.0 RAI Manual v1.18.11 Final (For 10/1/ 2023)
- MDS 3.0 RAI Manual v1.18.11 DRAFT (For 10/1/2023)
- MDS-3.0-RAI-Manual-v1.17.1_October_2019 (Expires 9/30/23)
- Technical Specifications MDS – Home Page
- New MDS Item Sets for 10/1/23 (Version 6)
- OBRA: Comprehensive | Quarterly
- PPS: 5 Day Initial Medicare | Part A PPS DC | IPA
- Other: OSA | OBRA DC
- List of all Item Changes
- List of State RAI Coordinators, Names, Emails by State
- OSA Manual and Item Set
New MDS 10/1/2023 – Training by section
- Understanding Changes To The MDS 3.0 For 10/1/23 (CMS)
- Training Program Overview (CMS)
- Section A: Social Determinants Of Health And New Data Elements (CMS)
- Section C: Changes To Cognitive Patterns (CMS)
- Section D: Resident Mood Interview And Total Severity Score (CMS)
- Section GG: Summary Of Changes (CMS)
- Section J: Health Conditions (CMS)
- Section K: Swallowing / Nutritional Status (CMS)
- Section N: Medications (CMS)
- Section O: Special Treatments, Procedures And Programs (CMS)
- Section Q: Participation In Assessment And Goal Setting (CMS)
resources
custom tools
- Montero Section GG Data Collection Tool to Determine Usual Performance: Used to support MDS coding
- Section O Therapy Days and Minutes
- Interpretation of Section O: Therapy Minutes, Days and Dates
- Section O: Restorative Nursing
- Respiratory Therapy MDS Audit Tool
3 CMS quality measure programs
Toolbox Content
cMS Quality measures
- CMS QM Home Page
- 5-Star Quality Rating System Technical Users Guide
- MDS 3.0 Quality Measures User’s Manual
- Appendix A of QM User’s Manual – Lists Measures Detail
- List of All Short Stay Measures vs Long Stay Measures
- CMS SNF Nursing Home Compare Database
- CMS SNF Nursing Home Provider Database
Nursing home compare
- Nursing Home Compare
- What is Nursing Home Compare and How Can It Help You?
- *Nursing Home Compare – Find Your SNF’s STAR Rating
- CMS SNF Nursing Home Compare Database
- CMS SNF Nursing Home Provider Database
- Learn How Ratings are Calculated
- View Long Term Care (LTC) Facility Staffing Payroll-Based Journal (PBJ) data
quality reporting Program (SNF QRP)
- CMS SNF QRP Home Page
- CMS Video Summary of SNF QRP
- SNF QRP FAQ CMS Document
- Skilled Nursing Facility Quality Reporting Program – Provider Data | Provider Data Catalog
- SNF Quality Reporting Program Spotlights & Announcements
- SNF Quality Reporting Program Training
- Brief Interview for Mental Status (BIMS) Video Tutorial
- Section GG Coding Training
- SNF Quality Reporting Program Public Reporting DATA
- SNF Quality Reporting Program Measures and Technical Information
- Measures
- SNF QRP Measure Calculation and Reporting User’s Manual
- SNF QRP – Old Manuals
- SNF QRP Table with MDS Questions Triggering 2% Penalty
- SNF QRP Data Submission Deadlines
sNF value based purchasing (SNF VBP)
- CMS SNF VBP Program Overview and Home Page
- SNF VBP Facility-Level Dataset | Provider Data
- SNF VBP Program Performance Score Report User Guide
- SNF VBP Score Overview – CMS YouTube Video
- CMS – Accessing SNF VBP Confidential Reports – Instructions/Tutorial
- Understanding the SNF VBP Report – Tutorial
- SNF VBP – Understanding Confidential Feedback Report
- MLN article (PDF) about the Program
- Public Reporting
- SNF VBP Program data are publicly available
Coding, billing & documentation
Toolbox Content
Clinical Resources
therapy
- Documentation:
- Fact Sheet: Requirements for Med A vs Med B
- Evaluation Templates (Medicare Compliant)
- PT | OT | Communication | Swallowing
- Progress Report Templates
- PT | OT | Communication | Swallowing
- Daily Treatment Encounter Note Templates
- PT | OT | Communication | Swallowing
- Home Evaluation Forms
- Objective Tests and Measures
- Tinetti Test
- Berg Balance Test
- Functional Reach Test
- Single Leg Stance Documentation Flow Sheet
- Tandem Stance Documentation Flow Sheet
- 4 Square Step Test Documentation Flow Sheet
- Maintenance Therapy Rules
- Jimmo Fact Sheet
- Jimmo Updates
- ICD-10-CM Code List: LTC Therapy Most Common Codes
- CPT Codes for PT, OT, SLP
- New CPT Therapy Evaluation Codes
- PT and OT Decision Chart for CPT Evaluation Codes by Complexity
- PT Decision Chart and Documentation Tool – Eval Codes by Complexity
- OT Decision Chart and Documentation Tool- Eval Codes by Complexity
- What is Skilled Therapy Fact Sheet
nursing
- Restorative Nursing Information – Section O of RAI Manual – Instructions
- Documentation Template – Montero Custom
- Respiratory Therapy MDS Audit Tool
- What is Skilled Nursing: Fact Sheet
- Nurse Aide Worksheet: Template
- Montero Sample PPS / Rehab Meeting – Data Collection Tool
- Montero Sample Medicare Part A Triple Check Form
- Montero Sample Therapy 3 Day Advanced Discharge Communication Form (to Nursing)
- MONTERO BNI Info-Guide / Cheat Sheet
- BNI Audit Form State Surveyors Use
- ABN Training Document From CMS
- Download and Customize:
- NOMNC Form (Medicare Part A & B) – CMS 10123
- DENC Form (Medicare Part A & B) – CMS 10124
- SNF ABN Form (Medicare Part A)-CMS 10055
- ABN CMS-R-131 (Medicare Part B)
ICD-10 Coding
Coding Manuals & resources
- CMS Home Page for ICD-10-CM Information
- CMS Guidelines for Coding
- ICD-10-CM Tabular List of Disease and Injury from CMS.gov
- ICD-10-CM Index List of Disease and Injury from CMS.gov
- ICD-10 Code Look-up Tool from CMS.gov
- For SNF CPT Codes – See Medicare Part B Toolbox for Cheat Sheet
compliance resources
Toolbox Content
State Survey Resources
SURVEY INTERVIEW AND OBSERVATION QUESTIONS & PROBES
- State Survey RESIDENT OBSERVATION Care Areas and Probes
- State Survey RESIDENT INTERVIEW Care Areas and Probes
- State Survey FAMILY INTERVIEW Care Areas and Probes
- State Survey RECORD REVIEW Care Areas and Probes
- State Survey Procedure Guide
- State Survey LTCSP Mapping Document
- State Survey List-of-Revised-FTags
OTHER TOOLS AND RESOURCES
- State Survey Entrance Conference Form
- Survey Preparation Tool for Therapy Staff
- State Survey – CMS Form 672 – Retired 10/1/23
- State Survey – CMS Form 802 – Data Collection and Instructions
- Survey Resources
- Revision History for LTC Survey Process Documents and Files
- State Operations Manual – Main Page
- Link to CMS State Operations Manual – Appendix PP
CRITICAL ELEMENT PATHWAYS: FORMS SURVEYORS USE TO AUDIT EACH AREA (Print)
- SNF Beneficiary Protection Notifications NOMNC ABN
- Dining Observation
- Infection Prevention, Control & Immunizations
- Kitchen Observation
- Medication Administration Observation
- Resident Council Interview
- Quality Assessment and Assurance (QAA) and Quality Assurance and Performance Improvement
- Abuse
- Environmental Observations
- Sufficient and Competent Nurse Staffing Review
- Personal Funds Review
- Activities
- Activities of Daily Living (ADL)
- Behavioral and Emotional Status
- Urinary Catheter or Urinary Tract Infection
- Communication and Sensory Problems (Includes Hearing and Vision)
- Dental Status and Services
- Dialysis
- General Care
- Hospice and End of Life Care and Services
- Death
- Nutrition
- Pain Recognition and Management
- Physical Restraints
- Pressure Ulcer/Injury
- Specialized Rehabilitative or Restorative Services
- Respiratory Care
- Unnecessary Medications, Psychotropic Medications, and Medication Regimen Review
- Medication Storage and Labeling
- Preadmission Screening and Resident Review
- Extended Survey
- Hydration
- Tube Feeding Status
- Positioning, Mobility & Range of Motion
- Hospitalization
- Bladder or Bowel Incontinence
- Accidents
- Neglect
- Resident Assessment MDS
- Discharge Planning
- Dementia Care
Management & Compliance
therapy department management
- Therapy Schedule and Minutes Tracker
- Billing and Tracking Forms: PT | OT | SLP
- Statistics and Report Forms
- Triple Check Meeting Forms Part A Part B
- Template Rehab Policy Manual (For Facility Members)
Therapy & Nursing compliance resources
- State Operations Manual
- Major Manual Update – New F-Tag Labels (Index)
- State Operations Manual
- Fact Sheet: Documentation Requirements for Med A vs Med B
- What is Skilled Therapy: Fact Sheet
- CMS Targeted Probe and Educate (TPE) Audits
*Disclaimer: Regulatory Information changes frequently throughout the year. It is the responsibility of the User to verify the accuracy of the information posted in the Toolbox and throughout the website. Documents implemented into practice by the User are done so at the sole risk of the User. Montero is not liable for how the information is used or interpreted by the User.