This deck was presented in an educational webinar for Paychex on payroll-based journal.

1. Payroll-Based Journal Reporting:
Strategies To Get Ready

2. PBJ Importance
• CMS is mandating that all Skilled Nursing
Facilities submit electronic census and
staffing information on a quarterly basis
– July 1st, 2016 is the first date providers
must start collecting this information
• Failure to submit or reporting inaccurate
data can be costly, potentially leading to
citation and civil money penalties.
(requirement of participation)
• Information used on Nursing Home
Compare
• Believed to be used in Five Star Quality
Ratings starting in 2018
1
July

3. Why Paychex Is Working With OnShift
• OnShift Software is the
leader in labor management
software for Skilled Nursing
Facilities
• Paychex is working with
OnShift because of OnShift’s
PBJ thought leadership and
100% focus on the industry
• OnShift has a proven
solution that can assist
Paychex clients meet this
requirement
+

4. Today’s Agenda
• Gain an in-depth
understanding of the new
PBJ requirements
• Find out what hours to
count and what not to count
• Learn what processes you
should implement today to
get ready
• OnShift PBJ Sneak Peek
• Questions & Answers

5. What is Payroll-Based Journal?
Payroll-Based Journal (PBJ) is a new system
used by CMS to electronically collect:
• Employee tenure information
• Direct care hours worked – including
agency and contractor hours
• Census data

6. Staffing Data: Current vs PBJ Practices
Current Practices
Future Payroll-Based Journal
Practices
Reported annually during survey
Reported electronically on a
quarterly basis
Reported using Forms 671/672
Reported using the Payroll-Based
Journal QIES system
Report staff hours for the most
recent complete pay period or 14
days prior to survey
Accounts for all direct care hours –
including contractor and agency –
for each day of the year
Includes employee tenure
information
Note: Current staffing reporting practices will still remain
in place even after the July 1st PBJ start date

7. Countdown to July 1
Fiscal Quarter Date Range for Staffing Data Submission Deadline
1 October 1 – December 31 February 14
2 January 1 – March 31 May 15
3 April 1 – June 30 August 14
4 July 1 – September 30 November 14
Aug
2015
Oct 1
2015
Registration for
voluntary
submission
Voluntary
submission
started
PBJ mandatory
collection begins
First mandatory
reporting
deadline
July 1
2016
Nov 14
2016

8. Starting Now: Getting Access
• Step 1:
– Go to www.qtso.com/accesspbj.html to register
– Use the CMSNet Online Registration application
to request a CMSNet User ID.
– The CMSNet ID is needed to access secure CMS
sites (e.g., submissions pages/reports) unless an
otherwise secure connection has been
established.

9. Starting Now: Getting Access
• Step 2:
– Use the QIES online User Registration tool to
obtain a QIES Submission ID.
– Once you have registered for a CMSNet User ID,
you will receive an email from
MDCN.mco@palmettogba.com containing your
login information. Using this information you will
connect through the 'CMS Secure Access
Service'.

10. Who Counts As Direct Care?
CMS defines direct care staff as 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 does not
include individuals whose primary duty is
maintaining the physical environment of the long-
term care facility (for example, housekeeping).

11. CMS Job Title Codes & DescriptionsLabor
Category
Code
Labor Description
Job
Title
Code
Job Description
1 Administration
Services
1 Administrator
2 Physician Services 2 Medical Director
2 Physician Services 3 Other Physician
2 Physician Services 4 Physician Assistant
3 Nursing Services 5 Registered Nurse Director of Nursing
3 Nursing Services 6 Registered Nurse with
Administrative Duties
3 Nursing Services 7 Registered Nurse
3 Nursing Services 8 Licensed Practical/Vocational Nurse
with Administrative Duties
3 Nursing Services 9 Licensed Practical/Vocational Nurse
3 Nursing Services 10 Certified Nurse Aide
3 Nursing Services 11 Nurse Aide in Training
3 Nursing Services 12 Medication Aide/Technician
3 Nursing Services 13 Nurse Practitioner
3 Nursing Services 14 Clinical Nurse Specialist
4 Pharmacy Services 15 Pharmacist
5 Dietary Services 16 Dietitian
5 Dietary Services 17 Paid Feeding Assistant
6 Therapeutic Services 18 Occupational Therapist
6 Therapeutic Services 19 Occupational Therapy Assistant
6 Therapeutic Services 20 Occupational Therapy Aide
Labor
Category
Code
Labor Description
Job
Title
Code
Job Description
6 Therapeutic Services 21 Physical Therapist
6 Therapeutic Services 22 Physical Therapy Assistant
6 Therapeutic Services 23 Physical Therapy Aide
6 Therapeutic Services 24 Respiratory Therapist
6 Therapeutic Services 25 Respiratory Therapy Technician
6 Therapeutic Services 26 Speech/Language Pathologist
6 Therapeutic Services 27 Therapeutic Recreation Specialist
6 Therapeutic Services 28 Qualified Activities Professional
6 Therapeutic Services 29 Other Activities Staff
6 Therapeutic Services 30 Qualified Social Worker
6 Therapeutic Services 31 Other Social Worker
7 Dental Services 32 Dentist
8 Podiatry Services 33 Podiatrist
9 Mental Health Services 34 Mental Health Service Worker
10 Vocational Services 35 Vocational Service Worker
11 Clinical Laboratory Services 36 Clinical Laboratory Service Worker
(OPTIONAL)
12 Diagnostic X-ray Services 37 Diagnostic X-ray Service Worker
(OPTIONAL)
13 Administration & Storage of
Blood Services
38 Blood Service Worker (OPTIONAL)
14 Housekeeping Services 39 Housekeeping Service Worker
(OPTIONAL)
15 Other Services 40 Other Service Worker (OPTIONAL)

12. Non-Facility Direct Care WorkersLabor Category
Code
Labor Description Job Title Code Job Description
2 Physician Services 2 Medical Director
2 Physician Services 3 Other Physician
2 Physician Services 4 Physician Assistant
4 Pharmacy Services 15 Pharmacist
5 Dietary Services 16 Dietitian
6 Therapeutic Services 18 Occupational Therapist
6 Therapeutic Services 19 Occupational Therapy Assistant
6 Therapeutic Services 20 Occupational Therapy Aide
6 Therapeutic Services 21 Physical Therapist
6 Therapeutic Services 22 Physical Therapy Assistant
6 Therapeutic Services 23 Physical Therapy Aide
6 Therapeutic Services 24 Respiratory Therapist
6 Therapeutic Services 25 Respiratory Therapy Technician
6 Therapeutic Services 26 Speech/Language Pathologist
6 Therapeutic Services 27 Therapeutic Recreation Specialist
6 Therapeutic Services 28 Qualified Activities Professional
7 Dental Services 32 Dentist
8 Podiatry Services 33 Podiatrist
9 Mental Health Services 34 Mental Health Service Worker
10 Vocational Services 35 Vocational Service Worker
11 Clinical Laboratory Services
12 Diagnostic X-ray Services
How will you
collect this
information?

13. Required Direct Care Worker Data
• Unique ID
– Must be unique and not duplicated
– Should not include personally
identifiable info (name or SSN)
• Hire date
• Termination date
• Pay type code
– Non-exempt – entitled to overtime
pay
– Exempt – not entitled to overtime
pay
– Contract – individuals under
contract or those that provide
services through organizations under
contract

14. Frequently Asked Question
• Do I have to collect and submit this information for
non-facility, contract and agency direct care workers?
Yes. This information must be submitted for all workers providing care in
your community. For agency and contract workers:
• Hire date for contract staff is defined as the first day worked and billed
for at your community
• Termination date for contract staff is the last day your community or
the agency communicates that the contract individual will no longer be
providing services at your community.
• If you are unsure, do not fill in the termination date.

15. Direct Care Staffing Hours
• Staffing hours data per direct care worker
– Work day and date
– Job title code
– Hours worked per day

16. Frequently Asked Question
• How should I report an employee’s hours where
their shift spans multiple days? For example a
Friday shift that begins at 11pm and ends
Saturday at 7am.
According to CMS, communities must allocate hours to the
actual days worked.
In this example, 1 hour should be reported for Friday and 7
hours should be reported for Saturday. Remember to account
for meal break as well on the applicable day.

17. What Hours Count, What Don’t
• Communities must submit the number of hours each staff member (including
agency and contract staff) is paid to deliver services for each day worked.
• CMS has highlighted instances when hours should not be included:
– Do not count hours paid for any type of leave or non-work related absence
from the facility, including paid meal breaks.
– Do not count any unpaid time worked.
• For example, if a salaried employee works 10 hours but is only paid for 8 hours, only 8
hours should be submitted.
– Do not count hours for services performed that are billed to FFS Medicare or
other payer.
– Do not count hours providing services to residents in non-certified beds.
• For example, if nursing home staff is shared with an assisted living community, only those
hours dedicated to the residents of the nursing home should be reported .

18. Frequently Asked Question
• How are we expected to report for staff who
perform different roles throughout their day?
1. If the system of record (e.g. time clock) is able to account for time worked in
different positions, then yes, you can split the time.
Example:
• Employee XYZ clocks in at 7:00 a.m. in the job code of CNA.
• Clocks out at 11:00 a.m. Has a half hour meal break.
• Clocks back in at 11:30 a.m. in the job code of Activities Aide.
• Clocks out at 3:00 p.m.
• System would record on that date: Employee XYZ CNA 4 hours; Employee
XYZ Activities Aide 3.5 hours.

19. Frequently Asked Question – Different Roles
2. It is understood that most roles have a variety of non-primary duties that are
conducted throughout the day (e.g., helping out others when needed). In these
cases, reporting should be based on the employee’s primary role and their official
categorical title (for example, as indicated in a Human Resources system).
Example
A CNA who goes to help hand out meal trays over the meal period for a short
amount of time. You wouldn’t want to try to separate out and attribute that 30
min. or so to a dietary duty.
3. Universal workers are more problematic because they probably do many different
jobs during the day (e.g. CNA, Dietary, Housekeeping, Laundry, etc.) and the time
spent doing each position would need to be captured in the system of record for
audit purposes. This would be more administratively burdensome such that the
facility may just want to report the major function of that shift (e.g. CNA).

20. Frequently Asked Question
• How should facilities report hours for staff who are
attending training? For example, a CNA might work in the
morning for 4 hours with residents and then have 3 hours
of in-service training in the afternoon.
According to CMS, If the direct care staff (e.g. CNA) attending
training (either onsite or offsite) is not available to provide
resident care, the hours that the nurse is in training should not
be reported. If another staff member is called in to fill in for a
nurse that is away for training, the hours for the called-in
nurse should be submitted. However, the hours for the nurse
in training may not be submitted.

21. Frequently Asked Question
• If an exempt employee works as a floor nurse to
fill-in when an employee has called off, can I
report those hours?
This must be handled very carefully so as not to run the risk of
violating the employee’s exempt status under FLSA rules, but
yes there is a way to report these additional hours.

22. Frequently Asked Question
• How do we report on hours that are not captured
in our time and attendance system (salaried &
corporate staff, therapy, contract)?
Data reported should be auditable and able to be verified
through either payroll, invoices, and/or tied back to a contract.
There is an expectation of accountability for services provided.
Facilities must use a reasonable methodology for calculating
and reporting the number of hours spent on site conducting
primary responsibilities, based on payments made for those
services.

23. Required Census Data
• PBJ requires that census
information be provided for
the last day of each month.
– 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
nor Medicare
Associations have
objected to only
submitting census data
for the last day of each
month. They view it as
misrepresentative and
unreliable in depicting
the hours of direct care
provided per resident
per day.

24. Utilize Technology
• Too many moving parts with
information in multiple systems
to do this all manually
• Software can provide the help
you get staffing right
– Meet PBJ/Five Star staffing
goals
– Automate scheduling & labor
management
– Staff to resident need and labor
budgets

25.  Meet PBJ staffing regulations
 Eliminate data gathering complexities
 Improve reporting accuracy with checks and balances
Payroll-Based Journal Reporting In 3 Easy Steps
Collect Review Submit

26. Payroll Based Journal
Sneak Peek
- Confidential -

27. OnShift For PBJ Reporting
• Product is available now
– XML successfully
submitted
• Set up process has
started!
OnShift is actively working with clients in preparation of the
July 1 deadline.
- Confidential -

28. Q
A
&