PBJ Accuracy Becomes Increasingly Important as a Measure of Quality

The Centers for Medicare and Medicaid Services (CMS) knows staffing within long-term care (LTC) facilities significantly affects the care delivered to residents. Guidance to Surveyors, F851, requires the quarterly electronic submission of payroll data to CMS. Payroll-Based Journal (PBJ) data more accurately depicts a facility’s staffing levels by reporting actual hours worked during the reporting period. CMS plans to use the PBJ data to also measure staffing turnover and longevity.

CMS began collecting auditable PBJ data July 1, 2016. Beginning June 1, 2018, quarterly PBJ data replaces the CMS 671 form for calculation of the facility’s staffing star rating on Nursing Home Compare (NHC). The CMS 671 form was completed only once a year during surveys while PBJ data will be used to update the Five-Star Quality Rating, quarterly.

RN hours per patient day (HPPD) and total nursing HPPDs are posted on NHC and are used to calculate the Five-Star Quality Rating. In late April 2018, Q4 2017 PBJ submissions were posted on NHC. Nearly 1,000 skilled nursing facilities (SNFs) noticed a new symbol on NHC, indicating the lack of PBJ data.

Beginning July 1, 2018, missing or erroneous PBJ data will result in the SNF’s staffing rating being set to one star for one quarter. This could also reduce the SNF’s overall rating by one star. More specific definitions of “missing or erroneous” data can be found in the May 2018 update to “Design for Nursing Home Compare Five-Star Quality Rating System: Technical Users’ Guide.”

CMS issued a memo to state survey agency directors (QSO-18-17-NH) on April 6, 2018, stating facilities reporting seven or more days in a quarter with no RN hours will receive a One-Star rating for staffing on NHC for that quarter. This change is effective July 2018.


Leadership best practices to ensure PBJ accuracy include:

  • Use CMS online training, policy manuals and FAQ documents.
  • Submit data with each payroll.
  • Review CASPER PBJ validation reports following each submission.
  • Use QAPI to support accuracy.

Pathway Health can support and assist your facility to become familiar with the various reports for monitoring your PBJ accuracy.

Contact us to learn how the experts at Pathway Health can help your organization reach higher to achieve success.

Karolee Alexander,
Director of Reimbursement and Clinical Consulting,
Pathway Health