Avoid PBJ Pitfalls
Nursing home providers should keep in mind that it is increasingly important to ensure that they are filing timely, accurate, and complete data when submitting quarterly Payroll-Based Journal (PBJ) staffing data. The data are the basis of the staffing ratings in the national 5-Star nursing home quality rating system and are now also used to calculate both staffing levels and contract staff utilization for purposes of the State’s Nursing Home Quality Initiative (NHQI). Homes that fail to file on time, are found to have filed inaccurate data, or do not respond within the established five-day time limit for audit document requests are downgraded to a single star in the staffing realm for one quarter of the year.
The Centers for Medicare and Medicaid Services (CMS) contracts with Granite Dolphin and Myers and Stauffer to audit whether homes are accurately reporting the required data. These are the entities with which providers interact during audits. Audit document requests are likely to cover information from payroll and timekeeping systems, invoices or contracts for contracted staff, and may include interviews with staff responsible for PBJ data entry and submission. Facilities whose audit identifies significant inaccuracies between the hours reported and the hours verified will be presumed to have low levels of staff. This will result in the facility receiving a one-star staffing rating, which will reduce the facility’s overall (composite) rating by one star for a quarter. Examples of significant inaccuracies are instances where the difference between the submitted hours and verified hours is large enough that it would change a facility’s star rating or change how the facility compares to its state’s average. CMS tends to impose the single star penalty on late and incomplete submissions as well as cases where significant inaccuracies have been identified regardless of the cause of the issue.
Based on member experiences and prior CMS comments, the following areas warrant special attention and may be audit triggers:
Meal Breaks. Meal breaks must be subtracted from PBJ-reported time regardless of whether staff worked through lunch or actually took the break. When reporting, you must deduct the time allotted for meals from each employee’s daily hours.
RN Staffing. Providers should ensure that they are meeting the requirement to have an RN on site for at least eight consecutive hours, seven days per week; that their reporting accurately reflects the hours; and that they are able to readily provide necessary documentation to back up the reporting.
Varying Roles and Universal Workers. While reporting is based on primary roles, CMS recognizes that staff may completely shift their primary role in a given day, and in those cases, facilities can change the designated job title and report hours under two titles for the employee. For facilities that use universal care workers, a reasonable methodology must be used to separate the time that the universal care worker spends performing their primary role from their time that is spent performing other activities. The PBJ Frequently Asked Questions (FAQs) provide further examples.
High, Low, and Fluctuating Hours. CMS and their contract auditors appear to focus on reporting that indicates unreasonably high or low work hours, large variations in weekday versus weekend staffing, as well as low weekend staffing.
Calendar Day Reporting. Staff hours must be reported on a calendar day basis. Providers are required to split shifts that straddle midnight into individual calendar days. For example, if an employee works a shift that starts at 11 p.m. and ends at 7 a.m., one hour would need to be reported for day 1, and the remaining six hours for day 2. CMS indicates that they understand that employees may be paid per shift and not per calendar day and will consider this when conducting audits.
Training Time. Hours for staff who are attending training (either on site or off site) and are not available to perform their primary role, such as providing resident care, shall not be reported. If another staff member is called in to fill in for staff participating in training, the hours for the replacement employee shall be reported.
CMS has also indicated in the past that homes reporting low weekend staffing and those failing to meet the daily required RN staffing would be referred to the state survey agency for potential closer scrutiny. Because daily census is an important component of the PBJ staffing calculation and is derived from Minimum Data Set (MDS) submissions, providers should ensure that MDS assessments, including discharge records, are filed in a timely way. The current PBJ Manual (November 2018) is available here, and a helpful FAQ document is here.
Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841