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Have you heard of PBJ?


CMS requires to submit electronically
or enter manually payroll data

Well, if you think it means peanut, butter and jelly ... we need to talk! It means Payroll-Based Journal Staffing Data Collection System (PBJ).

The Centers for Medicare and Medicaid Services (CMS) has long identified staffing as one of the vital components of a nursing home's ability to provide quality care. Over time, CMS has utilized staffing data for a myriad of purposes in an effort to more accurately and effectively gauge its impact on quality of care in nursing homes. As a result CMS has developed the PBJ data collection system.

A more detailed look:
CMS intends to collect staffing and census data through the PBJ system on a voluntary basis beginning on October 1, 2015, and on a mandatory basis beginning on July 1, 2016. CMS will require all nursing facilities to record hours worked for every staff category along with other information every day and this information must be submitted electronically on a quarterly basis and is due within 45 days following the end of each quarter. CMS proposes making compliance a condition of participation in the Medicare and/or Medicaid program.

The data, when combined with census information, can then be used to not only report on the level of staff in each nursing home, but also to report on employee turnover and tenure, which can impact the quality of care delivered. This system will allow staffing information to be collected on a regular and more frequent basis than currently collected.

CMS will audit the submitted staffing data for accuracy and will take enforcement actions against providers who are not in compliance with accuracy requirements.

Call us today to find out how GPS can assist you in understanding PBJ and help you to ensure your compliance with this new requirement.

More about CMS Payroll Based Journal ...

Download CMS information about PBJ ...

PBJ registration

Submission of PBJ staffing information has to be accessed through the Quality Improvement & Evaluation System (QIES). To connect to PBJ through QIES you must have a CMSnet user ID. Most long term care facilities may already have connectivity to QIES and CMSNet through submitting minimum data set (MDS) or other CMS data.

Individuals at facilities, e.g. vendors or corporate staff will need to register to submit data into the PBJ system. This is very similar to the process that has been in place with MDS data for years, and was recently updated to support both electronic plan of correct and hospice data submissions.

Registration for the PBJ system through QIES will begin in August 2015 for facilities that will submit data on a voluntary basis starting October 1, 2015 only.

Please visit the following websites for more information about PBJ registration and news:

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Are you ready and compliant?


Theresa Lewis will be happy
to explain the triple check

  • How are you ensuring you are in compliance with Medicare regulations with billing and coding?
  • Do your diagnosis codes match cross disciplines?
  • Who are the members of your triple check team?
  • Does your rehabilitation department help negotiate the triple check process?
  • Who is responsible for providing education regarding accuracy of RUGS-IV, HIPPS, modifiers, assessment reference dates, ICD-9 and ICD-10 coding, CPT coding?

Triple check is a policy and procedure outlined by CMS to ensure clinical aspects and billing are in compliance with Medicare policy.

Triple check proactively prevents billing denials, ADRs and non-payment issues secondary to non-adherence Medicare policy.

If you are looking for more information or would like assistance initiating or perfecting your triple check process please contact Joan Sirois for one free consultation.

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Are you ready for ICD-10?


Are you getting ready for ICD-10?

Are you concerned about:

  • benefits of ICD-10?
  • accurate clinical documentation?
  • loss of productivity due to coding?
  • billing implementation of ICD-10?
  • changes in denial efforts?
  • computer assisted coding?
  • R41.0, R51 or R45.2?

We can help you getting there: contact GPS!

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Claims, Denials and Audit Management

Webinar: How to prevent denials

In today's challenging economy health insurance premiums are often rising as reimbursement for providers is declining. Collecting reimbursement and ensuring the amount collected is correct is not easy and requires individuals who are well-trained, educated and experienced.

By implementing effective claims auditing and appeals processes you will overcome an increased administrative burden and you can ensure that you are paid appropriately for your procedures and services.

Streamline your processes:

  • Review your claims revenue workflow
  • Detect payment errors
  • Prepare, collect and submit your documents
  • Improve your claims audit and appeals procedures
  • Manage audits, claims and denials
  • Perform appropriate collection efforts

Contact GPS ...

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Medicare G-Codes and Functional Limitation Reporting

Webinar: Learn about the G-Codes

CMS committed to collect data on beneficiaries' functional outcomes from therapy services provided. This project is intended to support payment reform with outcome based data. To collect the data, CMS is using the collection method of "claim submission". Therapists are required to report "Functional Limitations" through a series of "G-Codes" and modifiers at the outset of treatment.

Watch our webinar to learn more about Medicare G-Codes, Functional Limitation Reporting and Claims based data collection strategies.

Do you know about the G-Codes?

  • Do you know who has to submit G-Codes?
  • Do you know how to collect data on beneficiaries' functional outcomes from therapy services?
  • Do you know that claims without the G-Code functional limitation data will be denied?

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