After CMS’ 2027 payment rule, “it’s going to be business as usual” for most facilities, except for two operational changes facilities should start preparing for, Jessie McGill, BSN, RN, senior curriculum development specialist at the American Association of Post-Acute Care Nursing, told Becker’s.
On July 29, CMS issued its final skilled nursing facility payment rule for fiscal year 2027. It increased payment by 2.4%, but for facilities that do not meet the SNF Quality Reporting Program requirements, that increase could actually be as low as 0.4%, Ms. McGill said.
“The high cost of medications, inflation and today’s labor wages all impact the profit margin of nursing facilities — and the 2.4% update definitely wasn’t substantial enough to really support growth in skilled nursing facilities,” she said. “The other thing that was a little disappointing is that we didn’t have a lot of other updates. There were no updates in consolidated billing, and there was no remapping for ICD-10 codes, even though we had suggested some remapping for the PDPM codes last year. We hope to have conversations with CMS in the future to make it more operational, but as it stands, there are still a lot of unanswered questions and concerns for the future.”
Payment struggles aren’t new to skilled nursing facilities, she said, and facilities are adept at working on a minimal margin and finding ways to survive. However, the rule did make a few operational changes that skilled nursing facilities should be preparing for now, including cutting the value-based purchasing deadline from 4.5 months to 45 days.
“This is one of the first things facilities will need to operationalize. It starts with quarter one of 2027, which ends March 31,” Ms. McGill said. “That means we have to operationalize that shortened deadline now. That takes some SNF reorganization to make sure we have time to review all the assessments and correct them as needed.”
One operational shift she recommends is to review the prior month at the end of each month, so staff do not have to process the entire quarter all at once.
Another notable operational change is the SNF QRP’s all-payer rule, which will require facilities to identify skilled level of care on admission for all payers. Ms. McGill encouraged all facilities to start looking for barriers to identifying payer types on admissions now, and work through those barriers before the rule takes effect in 2029.
Hospitals may play a key role in this operational change, especially by ensuring skilled nursing facilities know whether the patient had an inpatient acute stay or an observation stay.
“If we can fine-tune those processes with hospitals to ensure we have accurate information at the time a patient enters the SNF, that helps ensure accurate billing,” she said. “With the new SNF QRP all-payer policy, that distinction matters even more. Communication about the type of days used at the hospital is essential for accurately knowing the correct payer type at the SNF.”
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