Frequently Asked Questions about
Payroll-Based Journal


Payroll-Based Journal General

Payroll-Based Journal Requirements

In accordance with Section 6106 of the Affordable Care Act (ACA) skilled nursing facilities are required to electronically submit staffing information to drive accountability and consistency in reporting throughout the industry. Total direct care hours worked, including agency and contract staff, employee hire and termination date, and facility census must be included and auditable. This information will be used to report the level of staff (hours per patient day) plus employee tenure, retention and turnover – all of which have been found to impact the level of care provided to residents.

To facilitate this effort, the Centers for Medicare and Medicaid Services (CMS) has developed a system for facilities to submit staffing and census information – Payroll-Based Journal (PBJ). This system will allow staffing information to be collected on a regular and more frequent basis than currently collected. It will also be auditable to ensure accuracy.

Note: Only long-term care facilities that are subject to meeting the Requirements for Participation as specified in 42 CFR Part 483, Subpart B are subject to the PBJ reporting requirements. This requirement does not apply to swing beds.

 

Why PBJ Is Critical For Providers To Get Right

CMS has stated that the electronic Payroll-Based Journal staffing information is a requirement of participation and as such failure to submit, or reporting inaccurate data can be costly, potentially leading to citation and civil money penalties.

CMS, along with major provider associations, have long identified staffing as a key component in delivering quality care and ultimately positive resident outcomes. So much so, that CMS uses staffing information in the CMS Five-Star Quality Rating System to help consumers and referral sources understand the level and differences of staffing in nursing homes when selecting a facility.

For the time being, CMS will continue to require that providers submit Forms CMS 671 & CMS 672 at the time of survey to calculate the Staffing Domain of the Five Star Rating System. The switch to use submitted PBJ information for the Five Star staffing ratings will likely occur in late 2017 or early 2018.

The goal of the CMS Payroll-Based Journal (PBJ) is collect auditable data to track nursing home staffing levels and employee turnover and tenure, which can impact the quality of care delivered.  In order to achieve this goal, CMS will:

1. Collect staffing and census data regularly and more frequently (each quarter)
2. Ensure data is accurate by requiring it comes from an auditable source
3. Standardize the data that is collected

Long-term care facilities that are subject to meeting the Requirements for Participation as specified in 42 CFR Part 483, Subpart B are subject to PBJ reporting requirements. PBJ does not apply to swing beds.

Job Title codes identify the role a staff member has performed. Here is a full list of the CMS PBJ Job Titles:

Labor Category Code Job Title Code Labor Description Job Description Description of Services
1 1 Administration Services Administrator Administrative staff responsible for facility management as required under 483.75(d) such as the administrator and the assistant administrator.
2 2 Physician Services Medical Director A physician designated as responsible for implementation of resident care policies and coordination of medical care in the facilityin accordance with 483.75(i).
2 3 Physician Services Other Physician A salaried physician, other than the medical director, who supervises the care of residents when the attending physician is unavailable, and/or a physician(s) available to provide emergency services 24 hours a day.
2 4 Physician Services Physician Assistant A graduate of an accredited educational program for physician assistants who provides healthcare services typically performed by a physician, under the supervision of a physician.
3 5 Nursing Services Registered Nurse Director of Nursing Professional registered nurse(s) administratively responsible for managing and supervising nursing services within the facility. Do not additionally reflect these hours in any other category.
3 6 Nursing Services Registered Nurse with Administrative Duties Nurses (RN) who, as either a facility employee or contractor, perform the Resident Assessment Instrument function in the facility and do not perform direct care functions. Also include other RNs whose principal duties are spent conducting administrative functions. For example, the Assistant Director of Nursing is conducting educational/in-service. Facilities with an RN waiver who do not have an RN as DON report all administrative nursing hours in this category.
3 7 Nursing Services Registered Nurse Those persons licensed to practice as registered nurses in the State where the facility is located. Includes geriatric nurse practitioners and clinical nurse specialists who primarily perform nursing, not physician-delegated tasks. Do not include Registered Nurses’ hours reported elsewhere.
3 8 Nursing Services Licensed Practical/Vocational Nurse with Administrative Duties Those persons licensed to practice as licensed practical/vocational nurses in the State where the facility is located, and do not perform direct care functions. Also include other nurses whose principal duties are spent conducting administrative functions. For example, the LPN Charge Nurse is conducting educational/in-service, or other duties which are not considered to be direct care giving.
3 9 Nursing Services Licensed Practical/Vocational Nurse Those persons licensed to practice as licensed practical/vocational nurses in the State where the facility is located. Do not include those hours of LPN/LVNs reported elsewhere.
3 10 Nursing Services Certified Nurse Aide Individuals who have completed a State approved training and competency evaluation program, or competency evaluation program approved by the State, or have been determined competent as provided in 483.150 and who are providing nursing or nursing-related services to residents. Do not include volunteers.
3 11 Nursing Services Nurse Aide in Training Individuals who are in the first 4 months of employment and who are receiving training in a State approved Nurse Aide training and competency evaluation program and are providing nursing or Nursing related services for which they have been trained and are under the supervision of a licensed or registered nurse. Do not include volunteers.
3 12 Nursing Services Medication Aide/Technician Individuals, other than a licensed professional, who fulfill the State requirement for approval to administer medications to residents.
2 13 Physician Services Nurse Practitioner A registered nurse with specialized graduate education who is licensed by the state to diagnose and treat illness, independently or as part of a healthcare team.
3 14 Nursing Services Clinical Nurse Specialist A registered nurse with specialized graduate education who provides advanced nursing care.
4 15 Pharmacy Services Pharmacist The licensed pharmacist(s) who a facility is required to use for various purposes, including providing consultation on pharmacy services, establishing a system of records of controlled drugs, overseeing records and reconciling controlled drugs, and/or performing a monthly drug regimen review for each resident.
5 16 Dietary services Dietitian A person(s), employed full, part-time or on a consultant basis, who is either registered by the Commission of Dietetic Registration of the American Dietetic Association, or is qualified to be a dietitian on the basis of experience in identification of dietary needs, planning and implementation of dietary programs.
5 17 Dietary services Paid Feeding Assistant Person who meets the requirements specified in C.F.R. Section 483.35(h)(2) and who is paid to feed residents by a facility, or who is used under an arrangement with another agency or organization. Paid feeding assistants can only feed residents who do not have complicated feeding problems that would require the training of a nurse or nurse aide. Paid feeding assistants must not feed any residents with complicated feeding problems or perform any other nursing or nursingrelated tasks.
6 18 Therapeutic Services Occupational Therapist Persons licensed/registered as occupational therapists according to State law in the State in which the facility is located. Include OTs who spend less than 50 percent of their time as activities therapists.
6 19 Therapeutic Services Occupational Therapy Assistant Person(s) who, in accord with State law, have licenses/certification and specialized training to assist a licensed/certified/registered Occupational Therapist (OT) to carry out the OT’s comprehensive plan of care, without the direct supervision of the therapist. Include OT Assistants who spend less than 50 percent of their time as Activities Therapists.
6 20 Therapeutic Services Occupational Therapy Aide Person(s) who have specialized training to assist an OT to carry out the OT’s comprehensive plan of care under the direct supervision of the therapist, in accord with State law.
6 21 Therapeutic Services Physical Therapist Persons licensed/registered as physical therapists, according to State law where the facility is located.
6 22 Therapeutic Services Physical Therapy Assistant Person(s) who, in accord with State law, have licenses/certification and specialized training to assist a licensed/certified/registered Physical Therapist (PT) to carry out the PT’s comprehensive plan of care, without the direct supervision of the PT.
6 23 Therapeutic Services Physical Therapy Aide Person(s) who have specialized training to assist a PT to carry out the PT’s comprehensive plan of care under the direct supervision of the therapist, in accordance with State law.
6 24 Therapeutic Services Respiratory Therapist Persons(s) who are licensed under state law (except in Alaska) as respiratory therapists.
6 25 Therapeutic Services Respiratory Therapy Technician Person(s) who provide respiratory care under the direction of respiratory therapists and physicians
6 26 Therapeutic Services Speech/Language Pathologist Persons licensed/registered, according to State law where the facility is located, to provide speech therapy and related services (e.g., teaching a resident to swallow).
6 27 Therapeutic Services Therapeutic Recreation Specialist Person(s) who, in accordance with State law, are licensed/registered and are eligible for certification as a therapeutic recreation specialist by a recognized accrediting body.
6 28 Therapeutic Services Qualified Activities Professional Person(s) who meet the definition of activities professional at 483.15(f)(2)(i)(A) and (B) or 483.15(f)(2)(ii) or (iii) or (iv) and who are providing an on-going program of activities designed to meet residents’ interests and physical, mental or psychosocial needs. Do not include hours reported as Therapeutic Recreation Specialist, Occupational Therapist, OT Assistant, or other categories listed above.
6 29 Therapeutic Services Other Activities Staff Persons providing an on-going program of activities designed to meet residents’ needs and interests. Do not include volunteers or hours reported elsewhere.
6 30 Therapeutic Services Qualified Social Worker Person licensed to practice social work in the State where the facility is located, or if licensure is not required, persons with a bachelor’s degree in social work, a bachelor’s degree in a human services field including but not limited to sociology, special education, rehabilitation counseling and psychology, and one year of supervised social work experience in a health care setting working directly with elderly individuals.
6 31 Therapeutic Services Other Social Worker Person(s) other than the qualified social worker who are involved in providing medical social services to residents. Do not include volunteers.
7 32 Dental Services Dentist Persons licensed as dentists, according to State law where the facility is located, to provide routine and emergency dental services.
8 33 Podiatry Services Podiatrist Persons licensed/registered as podiatrists, according to State law where the facility is located, to provide podiatric care.
9 34 Mental Health Services Mental Health Service Worker Staff (excluding those included under therapeutic services) who provide programs of services targeted to residents’ mental, emotional, psychological, or psychiatric well-being and which are intended to: • Diagnose, describe, or evaluate a resident’s mental or emotional status; • Prevent deviations from mental or emotional well-being from developing; or • Treat the resident according to a planned regimen to assist him/her in regaining, maintaining, or increasing emotional abilities to function. Among the specific services included are psychotherapy and counseling, and administration and monitoring of psychotropic medications targeted to a psychiatric diagnosis.
10 35 Vocational Services Vocational Service Worker Evaluation and training aimed at assisting the resident to enter, re-enter, or maintain employment in the labor force, including training for jobs in integrated settings (i.e., those which have both disabled and nondisabled workers) as well as in special settings such as sheltered workshops.
11 36 Clinical Laboratory Services Clinical Laboratory Service Worker Entities that provide laboratory services and are approved by Medicare as independent laboratories or hospitals.
12 37 Diagnostic X-ray Services Diagnostic X-ray Service Worker Radiology services, ordered by a physician, for diagnosis of a disease or other medical condition.
13 38 Administration & Storage of Blood Services Blood Service Worker (optional) Blood bank and transfusion services.
14 39 Housekeeping Services Housekeeping Service Worker (optional) Services, including those of the maintenance department, necessary to maintain the environment. Includes equipment kept in a clean, safe, functioning and sanitary condition. Includes housekeeping services supervisor and facility engineer.
15 40 Other Services Other Service Worker (optional) Record total hours worked for all personnel not already recorded (For example, librarian).

We recommend you trial ezPBJ. They can easily convert your Excel worksheets to the CMS PBJ XML format.

The facility ID is NOT the Medicare ID, Medicaid ID, CCN or NPI.

The facility ID is a unique identifier assigned to the provider by the state agency.

 

CMS has published an Excel spreadsheet listing all CMS Facility IDs. To access the spreadsheet, connect to the CMS QIES System for providers and click on the Look Up Facility ID link (just below the PBJ Submissions link).

The next reporting deadline for CMS Payroll-Based Journal reporting is November 14, 2016. This deadline requires data for fiscal 2017 Quarter 1 which includes October 1, 2016 – December 31, 2016.

Nursing Home Compare is a website managed by the federal government that has detailed information about every Medicare and Medicaid-certified nursing home in the country.  It contains quality of care and staffing information for all 15,000 plus Medicare- and Medicaid-participating nursing homes.  The staffing data from the Payroll-Based Journal will eventually end up on Nursing Home Compare.

https://www.medicare.gov/NursingHomeCompare/

Staffing Hours

Direct Care Staff are “those individuals who, through interpersonal contact with residents or resident care management, provide care and services to allow residents to attain or maintain the highest practicable physical, mental, and psychosocial well-being. Direct care staff does not include individuals whose primary duty is maintaining the physical environment of the long term care facility (for example, housekeeping).”

Category: Staffing Hours

Job Title codes identify the role a staff member has performed. Here is a full list of the CMS PBJ Job Titles:

Labor Category Code Job Title Code Labor Description Job Description Description of Services
1 1 Administration Services Administrator Administrative staff responsible for facility management as required under 483.75(d) such as the administrator and the assistant administrator.
2 2 Physician Services Medical Director A physician designated as responsible for implementation of resident care policies and coordination of medical care in the facilityin accordance with 483.75(i).
2 3 Physician Services Other Physician A salaried physician, other than the medical director, who supervises the care of residents when the attending physician is unavailable, and/or a physician(s) available to provide emergency services 24 hours a day.
2 4 Physician Services Physician Assistant A graduate of an accredited educational program for physician assistants who provides healthcare services typically performed by a physician, under the supervision of a physician.
3 5 Nursing Services Registered Nurse Director of Nursing Professional registered nurse(s) administratively responsible for managing and supervising nursing services within the facility. Do not additionally reflect these hours in any other category.
3 6 Nursing Services Registered Nurse with Administrative Duties Nurses (RN) who, as either a facility employee or contractor, perform the Resident Assessment Instrument function in the facility and do not perform direct care functions. Also include other RNs whose principal duties are spent conducting administrative functions. For example, the Assistant Director of Nursing is conducting educational/in-service. Facilities with an RN waiver who do not have an RN as DON report all administrative nursing hours in this category.
3 7 Nursing Services Registered Nurse Those persons licensed to practice as registered nurses in the State where the facility is located. Includes geriatric nurse practitioners and clinical nurse specialists who primarily perform nursing, not physician-delegated tasks. Do not include Registered Nurses’ hours reported elsewhere.
3 8 Nursing Services Licensed Practical/Vocational Nurse with Administrative Duties Those persons licensed to practice as licensed practical/vocational nurses in the State where the facility is located, and do not perform direct care functions. Also include other nurses whose principal duties are spent conducting administrative functions. For example, the LPN Charge Nurse is conducting educational/in-service, or other duties which are not considered to be direct care giving.
3 9 Nursing Services Licensed Practical/Vocational Nurse Those persons licensed to practice as licensed practical/vocational nurses in the State where the facility is located. Do not include those hours of LPN/LVNs reported elsewhere.
3 10 Nursing Services Certified Nurse Aide Individuals who have completed a State approved training and competency evaluation program, or competency evaluation program approved by the State, or have been determined competent as provided in 483.150 and who are providing nursing or nursing-related services to residents. Do not include volunteers.
3 11 Nursing Services Nurse Aide in Training Individuals who are in the first 4 months of employment and who are receiving training in a State approved Nurse Aide training and competency evaluation program and are providing nursing or Nursing related services for which they have been trained and are under the supervision of a licensed or registered nurse. Do not include volunteers.
3 12 Nursing Services Medication Aide/Technician Individuals, other than a licensed professional, who fulfill the State requirement for approval to administer medications to residents.
2 13 Physician Services Nurse Practitioner A registered nurse with specialized graduate education who is licensed by the state to diagnose and treat illness, independently or as part of a healthcare team.
3 14 Nursing Services Clinical Nurse Specialist A registered nurse with specialized graduate education who provides advanced nursing care.
4 15 Pharmacy Services Pharmacist The licensed pharmacist(s) who a facility is required to use for various purposes, including providing consultation on pharmacy services, establishing a system of records of controlled drugs, overseeing records and reconciling controlled drugs, and/or performing a monthly drug regimen review for each resident.
5 16 Dietary services Dietitian A person(s), employed full, part-time or on a consultant basis, who is either registered by the Commission of Dietetic Registration of the American Dietetic Association, or is qualified to be a dietitian on the basis of experience in identification of dietary needs, planning and implementation of dietary programs.
5 17 Dietary services Paid Feeding Assistant Person who meets the requirements specified in C.F.R. Section 483.35(h)(2) and who is paid to feed residents by a facility, or who is used under an arrangement with another agency or organization. Paid feeding assistants can only feed residents who do not have complicated feeding problems that would require the training of a nurse or nurse aide. Paid feeding assistants must not feed any residents with complicated feeding problems or perform any other nursing or nursingrelated tasks.
6 18 Therapeutic Services Occupational Therapist Persons licensed/registered as occupational therapists according to State law in the State in which the facility is located. Include OTs who spend less than 50 percent of their time as activities therapists.
6 19 Therapeutic Services Occupational Therapy Assistant Person(s) who, in accord with State law, have licenses/certification and specialized training to assist a licensed/certified/registered Occupational Therapist (OT) to carry out the OT’s comprehensive plan of care, without the direct supervision of the therapist. Include OT Assistants who spend less than 50 percent of their time as Activities Therapists.
6 20 Therapeutic Services Occupational Therapy Aide Person(s) who have specialized training to assist an OT to carry out the OT’s comprehensive plan of care under the direct supervision of the therapist, in accord with State law.
6 21 Therapeutic Services Physical Therapist Persons licensed/registered as physical therapists, according to State law where the facility is located.
6 22 Therapeutic Services Physical Therapy Assistant Person(s) who, in accord with State law, have licenses/certification and specialized training to assist a licensed/certified/registered Physical Therapist (PT) to carry out the PT’s comprehensive plan of care, without the direct supervision of the PT.
6 23 Therapeutic Services Physical Therapy Aide Person(s) who have specialized training to assist a PT to carry out the PT’s comprehensive plan of care under the direct supervision of the therapist, in accordance with State law.
6 24 Therapeutic Services Respiratory Therapist Persons(s) who are licensed under state law (except in Alaska) as respiratory therapists.
6 25 Therapeutic Services Respiratory Therapy Technician Person(s) who provide respiratory care under the direction of respiratory therapists and physicians
6 26 Therapeutic Services Speech/Language Pathologist Persons licensed/registered, according to State law where the facility is located, to provide speech therapy and related services (e.g., teaching a resident to swallow).
6 27 Therapeutic Services Therapeutic Recreation Specialist Person(s) who, in accordance with State law, are licensed/registered and are eligible for certification as a therapeutic recreation specialist by a recognized accrediting body.
6 28 Therapeutic Services Qualified Activities Professional Person(s) who meet the definition of activities professional at 483.15(f)(2)(i)(A) and (B) or 483.15(f)(2)(ii) or (iii) or (iv) and who are providing an on-going program of activities designed to meet residents’ interests and physical, mental or psychosocial needs. Do not include hours reported as Therapeutic Recreation Specialist, Occupational Therapist, OT Assistant, or other categories listed above.
6 29 Therapeutic Services Other Activities Staff Persons providing an on-going program of activities designed to meet residents’ needs and interests. Do not include volunteers or hours reported elsewhere.
6 30 Therapeutic Services Qualified Social Worker Person licensed to practice social work in the State where the facility is located, or if licensure is not required, persons with a bachelor’s degree in social work, a bachelor’s degree in a human services field including but not limited to sociology, special education, rehabilitation counseling and psychology, and one year of supervised social work experience in a health care setting working directly with elderly individuals.
6 31 Therapeutic Services Other Social Worker Person(s) other than the qualified social worker who are involved in providing medical social services to residents. Do not include volunteers.
7 32 Dental Services Dentist Persons licensed as dentists, according to State law where the facility is located, to provide routine and emergency dental services.
8 33 Podiatry Services Podiatrist Persons licensed/registered as podiatrists, according to State law where the facility is located, to provide podiatric care.
9 34 Mental Health Services Mental Health Service Worker Staff (excluding those included under therapeutic services) who provide programs of services targeted to residents’ mental, emotional, psychological, or psychiatric well-being and which are intended to: • Diagnose, describe, or evaluate a resident’s mental or emotional status; • Prevent deviations from mental or emotional well-being from developing; or • Treat the resident according to a planned regimen to assist him/her in regaining, maintaining, or increasing emotional abilities to function. Among the specific services included are psychotherapy and counseling, and administration and monitoring of psychotropic medications targeted to a psychiatric diagnosis.
10 35 Vocational Services Vocational Service Worker Evaluation and training aimed at assisting the resident to enter, re-enter, or maintain employment in the labor force, including training for jobs in integrated settings (i.e., those which have both disabled and nondisabled workers) as well as in special settings such as sheltered workshops.
11 36 Clinical Laboratory Services Clinical Laboratory Service Worker Entities that provide laboratory services and are approved by Medicare as independent laboratories or hospitals.
12 37 Diagnostic X-ray Services Diagnostic X-ray Service Worker Radiology services, ordered by a physician, for diagnosis of a disease or other medical condition.
13 38 Administration & Storage of Blood Services Blood Service Worker (optional) Blood bank and transfusion services.
14 39 Housekeeping Services Housekeeping Service Worker (optional) Services, including those of the maintenance department, necessary to maintain the environment. Includes equipment kept in a clean, safe, functioning and sanitary condition. Includes housekeeping services supervisor and facility engineer.
15 40 Other Services Other Service Worker (optional) Record total hours worked for all personnel not already recorded (For example, librarian).

No, report only hours for contract staff that are billed directly to the skilled nursing facility.

Category: Staffing Hours

Medicare Advantage residents should be reported as “other”.

Category: Staffing Hours

No, you should not include time spent in new employee orientation. The only training hours that can be included are those when the employee is on the unit and available for direct patient care.

Category: Staffing Hours

For exempt staff, only report the hours paid. Do not report vacation, PTO, sick time, etc.

Category: Staffing Hours

No, paid vacation and sick time hours cannot be counted for PBJ.

Category: Staffing Hours

Census

No, do not count bedholds.

Category: Census

Medicaid – number of residents whose primary payer is Medicaid

Medicare – number of residents whose primary payer is Medicare

Other – number of residents whose primary payer is neither Medicaid or Medicare. Including:

  • Medicare Advantage (Part C)
  • Medicaid Managed Care
  • Medicaid Pending
Category: Census

CMS Connection and Submission

In order to access the CMS Payroll-Based Journal you will require two accounts:

1. CMSNet User ID to access secure CMS sites. To request this account, visit: CMSNet Online Registration.

2. QIES Submission ID to access the Payroll-Based Journal and CASPER Reporting websites. When you register for a CMSNet User ID, you will be emailed instructions to connect to the “CMS Secure Access Service”. Once securely connected, select the “CMS QIES Systems for Providers” link to access the QIES online “User Registration” tool.

For more information, please visit https://www.qtso.com/accesspbj.html

Logging into the CMS Payroll-Based Journal is a multi-step process:

  • 1. Go to the QTSO submission access page: https://www.qtso.com/submissions/submissions.html. Click on your state and follow the prompts.
  • 2. Enter your CMS Secure Access Service account username and password. This will connect you to the CMS network allowing you access to their private websites (including PBJ).
  • 3. The QIES System webpage will be displayed. Click on the PBJ Submissions link.
  • 4. Enter your PBJ user id and password. This is a different account then you used for CMS Secure Access Service.

Uploading a CMS PBJ XML file is a multi-step process:

  • 1. Make sure your zipped XML is in a local folder since the CMS Secure Access Service will disconnect network drives.
  • 2. Connect to the CMS Secure Access Service and then navigate to the PBJ system (more info above).
  • 3. Once you’re in the PBJ system, click the Upload Data File menu item.
  • 4. Select the Federal Fiscal Quarter. Make sure you select the Federal Fiscal Quarter and not the regular calendar quarter.
  • 5. Click Browse… and select your zipped XML file.
  • 6. Click the Upload File button
  • 7. Write down or print the Submission ID.
  • 8. Review the PBJ Final File Validation Report from the CASPER Reporting system.
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The facility ID is NOT the Medicare ID, Medicaid ID, CCN or NPI.

The facility ID is a unique identifier assigned to the provider by the state agency.

 

CMS has published an Excel spreadsheet listing all CMS Facility IDs. To access the spreadsheet, connect to the CMS QIES System for providers and click on the Look Up Facility ID link (just below the PBJ Submissions link).