Dykema Gossett PLLC

Homeostasis: Health Care Law Blog

Act Now to Protect Your Two Percent!


Act Now to Protect Your Two Percent!

The IMPACT Act of 2014 requires skilled nursing facilities (SNFs) to submit quality data to the federal Centers for Medicare and Medicaid Services(CMS). Failure to do so on a timely basis will shave two percent off the SNF’s Medicare reimbursement for the next federal fiscal year.

CMS is now sending notices to SNFs that it believes did not comply with reporting requirements during calendar 2017. Such SNFs are slated to lose two percent of their Medicare payments for federal fiscal year 2019 (FY19), which starts on October 1, 2018. SNFs can request a reconsideration and ultimately an administrative appeal of these CMS determinations, but they have to act quickly. The filing deadline is August 7, 2018[1] in order to protect Medicare payments for FY19.

Reconsideration requests must be sent by email to SNFQRPReconsiderations@cms.hhs.gov, using the subject line “SNF QRP Reconsideration Request” and include the SNF CMS Certification Number (CCN). The request must explain why the SNF believes that the CMS determination of non-compliance is erroneous, and must include supporting documentation. If CMS upholds its non-compliance determination upon reconsideration, the SNF may file an administrative appeal to the Provider Reimbursement Review Board (PRRB).

For future federal fiscal years, SNFs can be proactive if they anticipate difficulty complying with quality data reporting requirements. If a SNF experiences an extraordinary circumstance beyond its control, it can request either an extension of time to report the data or an exception from reporting for a specific time period. Such requests are due within ninety days of the extraordinary event, and may be granted for one or more quarters’ worth of reporting. These requests are sent by email to SNFQRPReconsiderations@cms.hhs.gov with the subject line “Disaster Exception or Extension Request” and the SNF’s CCN.

For most SNFs, two percent of its total Medicare reimbursement is a significant amount of money. SNFs should not jeopardize it by failing to request a reconsideration when the facts and circumstances warrant one. SNFs also should review QRP reporting policies and procedures to avoid problems in the future and add QRP extensions/exception requests to the list of tasks in the SNF’s emergency preparedness/response plan. Protect what is yours!

 To sign up for Dykema’s Health Care Blog e-mail updates, please click here.

[1] Reconsideration requests must be filed within 30 days from the date on the CMS non-compliance notice. A recent CMS subscription eblast states that non-compliance notices were sent on July 7 and that reconsiderations are therefore due on August 7, 2018. If a particular SNF receives a non-compliance notice on a different date, it could be argued that it has 30 days from that date to file a reconsideration.