CMS has released the final SNF PPS updates to the FY 2025 payment rates effective 10/1/24. These rates apply to traditional Medicare Part A, PDPM reimbursement.
The reported 4.1 – 4.2% increase published does not include the updated Wage Index impact, the Value Based Purchasing (VBP) multiplier established by CMS, nor the QRP potential 2% impact based on meeting the 90% completion threshold and vaccination reporting. To view the final rule in the Federal Register, click here.
For additional clarity to help estimate the impact of these changes, please find the below resources:
- Updated Rate Calculator (in partnership with Data IQ)
- View the updates here.
- The items below have been updated for all facilities included in this FY 2025 Rate Calculator:
- Base Rates and CMI
- Year over Year (YoY) Base Rate Comparison
- Wage Index
- Wage Importance Factor – up to 72% from 71.1% in 2024
- Please note, VBP has carried over from 2024 and the 2% QRP potential impact is not included (VBP will be updated as soon as released publicly)
- SNF VBP Update
- The SNF VBP Performance reports are in providers’ iQIES inboxes or wherever they receive their CMS automated reports (Simple, etc.). The Excel download report and page-2 of the workbook provide scores and incentive payment multiplier for FY2025 (also reference the iQIES manual linked under the next bullet that details how to find these reports).
- QRP
- QRP Threshold reports can be pulled or requested from iQIES. Click here to view the iQIES Reports User’s Manual for visuals/screenshots on how to find a report and request it.
- ICD-10 Mapping Changes:
- CMS has updated mappings of ICD-10 codes to capture the Clinical Category more accurately, SLP co-morbidities, and NTA determinations.
- Click here to view the updated Mapping Tool.
- Note: The final rule also details proposed changes to the NTA component with an RFI for future determination.
The Point Is: While the reported annual payment update is an appreciated increase, it is critical to factor in the Wage Index, VBP, and QRP to more closely establish the impact that will be recognized beginning 10/1/24 under the traditional Part A PDPM reimbursement model. (Personal note, wouldn’t it be lovely if the Managed Care payors would follow suit?). QRM values the incredible effort carried out day in and day out in every community to provide quality care to our SNF population.
