MDS Alert

What went wrong? Understand what these new and revised edit codes mean.

Even before the mandatory reporting period has begun for the Payroll Based Journal (PBJ) electronic staffing data submission, the Centers for Medicare & Medicaid Services (CMS) has already come out with an updated version of the PBJ system’s data submission specifications. Don’t let these changes trip you up, especially if you’ve been participating in the voluntary submission period.

CMS released the PBJ 2.0 Data Submission Specifications Version 2.00.0 on Jan. 15, but these specifications will go into effect on June 26, when the mandatory reporting period begins. In the updated data submission specs, CMS has added, deleted, and revised a handful of items and edits.

Pay Attention to Deleted & Revised Items

First, CMS deleted the item workTypeCode, which was part of the items in the voluntary period but won’t be in the PBJ data specs for the mandatory reporting period. Although CMS didn’t add any new items, the following three items underwent various revisions:

• fileSpecVersion (specifications version code) is updated from Version 1.00.1 for the voluntary reporting period to 2.00.0 for the mandatory period, beginning on June 26. This item is part of the Header section.
• payTypeCode (pay type code) is no longer part of the Employee section and is now included in the Staffing section. For this item, you must enter one of the following values: 1 (exempt); 2 (non-exempt); or 3 (contract).
• jobTitleCode (job title code) contains revised codes. Code 17, previously listed as Food Service Worker, is now Feeding Assistant, and codes 38, 39, and 40 now have “optional” in their descriptions.

What You Need to Know about Edits

Background: CMS has assigned each edit a numeric “edit ID” code, used on the PBJ system feedback reports. The Detailed Data Specifications Report will list edits under every item to which they apply. You should also receive a second report, called the Unduplicated Edit Report, which lists each edit only once and references all the items to which each edit applies.

CMS has also categorized the edits by type and severity. The edit types are:

• Format — Specifies special rules for formatting item values.
• Consistency — Defines logical constraints among multiple items.
• Information — Identifies items for which submission is optional.

The severity of each item describes the impact of violating the edit. There are only two possible severity scores:

• Fatal — Violation of a fatal edit will result in rejection of the submitted XML file. Format edits are always fatal, and most consistency edits are fatal but some are warnings.
• Warning — Violation of a warning edit will result in a warning message on the user feedback report. A warning edit will not prevent the PBJ system from accepting and storing the submitted data.

Watch for 3 New Edits

In the new PBJ data specs, CMS has added three new consistency edits, two of which are fatal and one is a warning:

• -1009 (Consistency/Fatal) could come up for hire date (hireDate), termination date (terminationDate), date of the work day (date), or census month end date (monthEndDate). If you see this edit, check the year for accuracy — the edit will trigger if the date does not contain a year equal to or greater than 1895.
• -1010 (Consistency/Warning) replaces edits -4014 and -5000. This edit may arise from the reporting quarter (reportQuarter), date of the work day, or the census month end date. You could see this edit if the value for the date of the work day in the Staffing Hours section is not within the date range of the reporting quarter (specified in the Header section of the PBJ submission file). The edit will also come up if the value for the census month end date in the Census section is not within the range of the reporting quarter.
• -5001 (Consistency/Fatal) may arise if an employee identifier (employeeID) item value appears more than once within the Employee section of a PBJ XML submission file.

How 4 Edits Have Changed

CMS has also made some key changes to other edits in the PBJ system; these include:

• -3679 (Format/Fatal) no longer contains in the edit description: “Signed numbers (with a leading plus or minus sign) will not be accepted.” This edit applies to the following items:

    o Federal Fiscal report year (federalFiscalYear)
    o Hours worked for job title code (jobTitleCode) on date (hours)
    o Medicaid resident count — last day of month (medicaid)
    o Medicare resident count — last day of month (medicare)
    o Other resident count — last day of month (other)

For these items, you may submit only the values listed in the “Item Values” table of the Detailed Data Specifications Report. Also, the submitted value must be greater than or equal to the minimum value listed in the table and less than or equal to the maximum value listed in the table, or it must match one of the remaining special values (if any) that are listed in the table.

• -4006 (Consistency/Fatal) now has mapping added to item pay type code (payTypeCode), since it is now part of the Staffing Hours section. Whenever you include the Staffing Hours section in a PBJ submission file, you must include the following items:

    o Employee identifier
    o Pay type code
    o Date of the work day
    o Hours worked for jobTitleCode on date
    o Job title code

• -4013 (Consistency/Fatal) now states that you may change only the most recent employee record. This edit applies to the hire date and termination date items. If you submit either of these items for an employee who already exists in the PBJ database, you must abide by the following rules:

    o You may change only the most recent hire data and termination date for the most recent employee record; and
    o You may change the hire date and termination date for the most recent employee record only to dates that are greater than any existing termination date; otherwise, the PBJ system will reject the submission file.

• -4015 (Consistency/Fatal) underwent a revision to remove “worked” from the describing hours. This edit applies to the date of the work day and hours worked for jobTitleCode on date. The edit description now states: “The total number of hours by an employee for a single date must be less than or equal to 24.00. This total includes the sum of all hours across all jobTitleCodes for the specified date.”

Deleted: Also note that CMS deleted edits -4014 and -5000, both of which were replaced by the new edit -1010.

Resources: For more instructions on PBJ submissions, as well as the Version 2.0 Data Submission Specifications, go to www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.html.