An overview of the section of the Affordable Care Act that mandates all long-term care facilities to submit data about employees working in direct care called a Payroll-Based Journal.
What is a Payroll-Based Journal?
Employee turnover and length of tenure in long-term care facilities and nursing homes is one of the most important aspects of quality care, according to the Center for Medicare and Medicaid Services (CMS).
That’s why it’s especially important to track staff data at these facilities and for consumers to be aware of the quality of staff when they make buying decisions.
In an effort to exponentially increase the accuracy and transparency required of nursing home staff data reporting, Section 6106 of the Affordable Care Act (ACA) created a new Payroll-Based Journal (PBJ) mandate.
The law enforces a requirement in which all “long-term care facilities” are mandated to submit data about employees working in direct care.
The PBJ submission program wasn’t always compulsory. When it was first launched on Oct. 1, 2015, it was optional. But in order to expand the program, encourage improvement in an industry that struggles with understaffing and provide better data to consumers, the ACA made the journal mandatory on July 1, 2016.
Every long-term care facility has 45 days from the end of each quarter to submit the previous quarter’s report to the CMS.
As of November 2017, the CMS began to use the collected data to create a five-star direct care provider rating system, employed in the search system available on medicare.gov to help users compare the quality of nursing homes around the country. The grades are based on four criteria:
- Health inspections
- Quality measures
This data also allows the CMS to ensure more quality care of homes around the country and verify that these facilities maintain an acceptable and functional level of staff on hand at all times.
Who Needs to Use a Payroll-Based Journal, and Who Must Be Reported?
The ACA specifically states that the PBJ reporting requirement applies to all long-term care medical and nursing facilities.
Long-term care facilities are defined as any location that provides skilled nursing services to residents or patients who require everyday aid with activities. In addition to nursing homes, these facilities also can include rehab centers, inpatient behavioral health facilities and long-term chronic care hospitals.
Locations that fit this definition are required to catalog and submit extensively detailed quarterly data on all employees who work in direct-care-related positions. This includes employees who are employed both as agency staff and contract staff.
The CMS defines “direct-care staff” as any employee who uses a social or interpersonal skill set to provide care or is tasked with the residential care management to provide healthcare or other services that improve or sustain the mental, physical or psychological health and wellness of the patient or resident. This can include nursing staff, management and more.
However, some employees often employed at long-term care facilities are not required to be included in the PBJ reports because they do not fit the “direct-care” description. For example, janitors, housekeeping, maintenance, tech support and other staff responsible for repairs, cleaning and routine upkeep of the facility are not considered direct-care employees.
Corporate staff hours, on the other hand, only should be reported when those staff members are performing duties that directly involve resident care.
Long-term care facilities include data in their PBJ report that supports the United States Census by tracking resident data. On a monthly basis, the facility is required to report how many residents pay primarily via Medicaid, Medicare or “other.”
What Kind of Data Is Required in a Payroll-Based Journal?
The CMS developed a specific PBJ reporting system in order to streamline the reporting process and better handle the flow of large quantities of highly specific, detailed employee information.
For the official, comprehensive rundown of the PBJ process, visit the official CMS website. The page also includes registration material so that you’re officially prepared to file your report at the end of the quarter.
Long-term care facilities are required to list every individual employee working in direct care. The CMS’s PBJ system organizes employees into 40 individual job types, each with an associated labor category code and job title code. Each of these categories will need to be included when listing every individual employee, along with that employee’s hours and the day those hours were worked.
Required information data points about direct-care employees include:
- Unique employee ID.
- Employee’s hire date.
- Termination date (if applicable).
- Pay type code (non-exempt, exempt or contract).
- The workday and date.
- The job category code.
- The job title code.
- The hours worked per day and date.
How to Submit a Payroll-Based Journal
A PBJ can be submitted to the CMS via its website in three ways:
- Automatically with a pre-prepared XML file of up to 5 MB. This works similarly to how MDS data is currently submitted. The data must meet technical requirements established by the CMS, however. These requirements are established in documentation located here. The CMS also established a tech-support email for any further questions when formatting your XML, which is: NursingHomePBJTechIssues@cms.hhs.gov
- Manually by entering each employee line by line into the CMS system on its website. The PBJ user interface was designed to be intuitive, quick and easy to operate.
- Through both methods—whatever information is not included on your XML file can be added manually line by line into the CMS system afterward.
Employers are required to be specific and exact when tracking an individual staff member’s hours at the proper date and time under the corresponding labor category and job title code. In the case of employees who work night shifts over the course of two separate days, two individual entries are required for the single shift.
The hours of employees who are paid directly by Medicare are not required to be reported in your PBJ submission.
It’s important to be as specific and detailed as possible about the functions and duties each employee performs. Employees who transition to different duties during the course of a shift (for instance, occupational therapy one half of the day and advisory services the second half of the day) should be categorized with separate job codes for each half of the shift. The CMS reporting system will allow for this when entering data.
Nursing Home Compare and the Five-Star System
As mentioned above, all data gathered by the CMS via the PBJ report will be used for the Nursing Home Compare tool to inform the five-star quality rating system, which will measure each long-term care facility.
You can view the mathematical metrics (a system that compares the number of employee hours against the number of residents) by which the rating system is created on the CMS website here. A more technical documentation of the system is available and continuously being updated here.
There’s always the potential of a records audit since these reports have been submitted in good faith. If the facility is selected, it will be contacted both by email and certified mail.
If there are minor errors in the PBJ report after a CMS audit, the employers will be notified by the CMS after completion, and the CMS is actually very willing to work with the employer to correct those discrepancies and work to avoid errors in reporting in the future.
However, large and significant inaccuracies can impact the facility’s star rating—most likely resulting in a one-star rating in the staffing category for the quarter.
As an example of a discrepancy large enough to penalize, the CMS listed “instances where the difference between the submitted hours and verified hours is large enough that it would change a facility's star rating or change how the facility compares to its state average.”
Failure to report also will cause a long-term care facility to immediately receive a single star in the staffing category for the quarter.
Partner with Complete Payroll
If you’re looking for help with human resources and payroll for your small to midsize business, why not turn to the company that recognizes humans are more than just resources?
We apply innovative payroll solutions, and our payroll system comes complete with PBJ reporting built-in so you don’t have to worry about any complications. Plus, our time and attendance solutions make compliance easier.
If you want to make the most of human resources and payroll in your company, visit our website and reach out today.
Hunt Hollow Ski Club
Hunt Hollow Ski Club has tried other payroll companies from time to time, but always return to Complete Payroll because we have an assigned specialist who knows our needs inside and out, is knowledgeable, easy to reach and very responsive. My questions and concerns are addressed in a VERY timely manner and I never feel that I have to handle sticky issues alone.
Soderberg Insurance Services Inc
I have been working with Lacy Smart and her team for the last few years. I have been impressed by her responsiveness, accuracy, and high level of providing client satisfaction. She and her team are a wonderful testament to the organization!
Kenrick Maintenance Corporation
Ashley from Complete Payroll has always been helpful. It seems that whenever we have a challenge, Ashley is there to help us through and does it well. Her customer service skills are excellent.
Nuttall Golf Cars Inc
I have worked with a few different payroll providers during my career. Complete Payroll is absolutely, by far, the most proficient and customer service-oriented provider I have been privileged to work with. Lindsay Ezard goes above and beyond to assist me with any question I may have. Thank You Lindsay!
The team at Complete Payroll is always responsive, always helpful, and always professional. They have gone above and beyond over recent years to assist Keuka College in creating efficiencies, maintaining compliance, and improving processes. Complete Payroll is a trusted partner, a valued resource, and a respected adviser.
Rochester Hearing and Speech
My experience with Complete Payroll has been exceptional. I was a novice to payroll so my learning curve was big. Andrea is wonderful helping me navigate payroll and not just fixing my errors but explaining what I did or did not do.
Finger Lakes Wrestling Club Inc
We were referred to Complete Payroll years ago by a board member and haven't looked back since. When I first started working with them, I knew nothing about payroll. My first rep Lacey, and now JoAnn, are great to work with. Working with Complete Payroll has just been a wonderful all-around experience for me.
Hilton Health Care PC
We very much appreciate the quick service. If I need a special report it arrives via email within one business day, if not that day.
Dr. Christopher Mozrall
Complete Payroll is a great payroll company, and we love Lacey! She always has the answers to my questions without hesitation. There is very little (if any) wait time to get a call back.
Shear Ego Salon & Spa
The first suggestion I made after I joined Shear Ego was that if they were not yet using Complete Payroll, they should be. We continue to be impressed and happy with the quality and friendliness of service, and the excellent newsletters and up-to-date information on all things payroll and HR.
Boulevard Van City
We moved to Complete Payroll about 3 years ago. It was seamless and working with Lacy Smart on Mondays is a breeze.
People do business with people, not with corporations. In over 20 years, we have only had two customer service reps. Instead of feeling like we are one of 10,000, CP makes us feel like family! We count on Lindsay getting it right, and she always does. Even when we go outside the box, all is as we expect it!
Complete Payroll fits my budget, I never get bounced around between customer service reps, and it's very easy to enter my payroll. I simply take a photo of my payroll sheet and email it to my rep. There's never a problem! With them, it's business done, and business done right.
Town of Bergen NY
Complete Payroll Processing provided an easy transition from internal payroll processing. With payroll as their core competency, CP has the expertise to help mitigate errors and ease the burden of annual updates. Comprehensive reporting gives all the details needed and an organization can operate with an added piece of mind knowing that the payroll service is taken care of.
After nearly 10 years, we are receiving the same or better service than when we started. The ability to reach our dedicated customer service representative in a timely manner is huge when there are deadlines in play. Requests for unique reports and integration with our other vendors has been handled without hesitation. We truly feel a partnership with Complete Payroll.
I am very happy with your service and your website is easy to use. Employees are so responsive and ready to help with any questions. Andrea responds quickly to email, Tracy did everything from the beginning to get us started understanding and entering payroll, and Sydney's training was just super helpful.
I just love Lindsay! She does an awesome job! She is very responsive and I like that she teaches me how to find things rather than just doing it for me.
English Road Pediatrics & Adolescent Medicine, LLC
When our business began in 2005 I knew right away which payroll company we would use. I have had exactly 2 payroll specialists since then, and I feel like they know me & our company. I am not shy to ask questions & if they don't know the answer I am always pointed in the right direction. I have every confidence in my payroll specialist, Lindsay and the company she is with!
Mack's Body Shop, Inc.
I have had the great pleasure of working with Payroll Country for almost two years now. Tiffany was my original CSR and was very helpful, courteous, and was always there whenever I needed help. So far, my experience with my new rep, John, has been wonderful as well. I look forward to working with Complete Payroll for many years to come!
H Clarke Services
We have been with Complete Payroll for quite awhile now and plan on staying. Thanks!
Watch Howard's Testimonial
Crossroads House has been using Complete Payroll for several years now. Their service is fast, friendly and accurate. Whenever we have payroll documentation needs arise for our employees, Complete Payroll always gets the job done quickly and efficiently. We are proud to count them as one of our many community partners.
Swagelok Western New York
We have received excellent and attentive service for over 10 years now. We have come to rely on Complete Payroll's consistency and very low turnover. We appreciate the chance to know our rep and they get to know us and our needs as a business. If we have payroll or general HR questions, Complete Payroll has the answers for us.
Inn at Houghton Creek
Great customer service combined with a reduction in processing fees made the decision to stay with Complete Payroll an easy one. Our customer service representative, Kendall, always gets back to us quickly, and she is always very helpful and friendly. Also, the training that we received from LeeAnn was thorough and beneficial.
Town Of Pembroke
We have been well served by Complete Payroll. When we have needed support, it was given both in payroll and other employee matters, like handbooks.
Antonucci Law Firm
It has been great working with everyone from Complete payroll. Everyone through the years have always been great. They take your phone calls every time, and always go above and beyond what you need. We have been customers for years and will continue for years.
The Service Collaborative of WNY, Inc.
We have been using Complete Payroll for over five years and have found them to be responsive, professional, friendly, and cost effective. Customer service is best judged when something goes wrong. Complete Payroll is always there immediately to help fix the issue. Complete Payroll is a payroll partner, not just a payroll service.
Tiffany Transportation Services LTD.
I have worked with many payroll companies throughout my career and Complete Payroll surpasses them all in personalized service. My CSR is Andrea and I have always received assistance in a timely manner. Keep up the great job!
Olean Wholesale Grocery Coop., Inc.
Complete Payroll is the best choice that I have made for our payroll and HR services. Anytime I have called customer service, there is always a happy and knowledgeable person on the line to help us out! They have done anything I have asked of them in a quick and efficient manner! I would recommend them to anybody!
Financial Service Company
What I love most about Complete Payroll is the quick resolution and response. There are not many issues, but like anything in life, issues happen. Complete Payroll is the best at acknowledging the issue and resolving the problem quickly. My rep is fantastic to work with, and I refer Complete Payroll whenever I can!
Fillmore Wesleyan Church
I've been very pleased with the service and responsiveness of my CSR, and CP's continued dedication to provide us with all the tools we need to have a successful payroll and HR experience. You are always available when I have a question and always make sure that any problems that arise are worked through to my satisfaction.
Elite Armed Response Service, LLC
I can not fully express my satisfaction with Complete Payroll's personalized service, directed to my specific business needs. They are always there to make suggestions on how to make my experience better. I highly recommend Complete Payroll to anyone that has a business, large or small. You will not be disappointed!
A Gust of Sun Winery
Complete Payroll has, by far, been the easiest and friendliest company we have ever worked with. They are quick to respond to any questions I am having, and they also have a great pricing structure.
Central American Healthcare Initiative Inc.
The attention to detail in the customer experience and the consistent friendliness of the Complete Payroll team really make the difference. Liz, Mona, LeeAnne, Brandi, and Lacy have all been great to work with.
Brian Horn's Auto Repair, Inc.
Complete Payroll's service, loyalty, and family atmosphere is second to none! We NEVER have any mistakes, and payroll is always on time. When I have a "Brain Fart" and forget to call in payroll, my rep Lindsey has my back. Our company will always be with Complete Payroll, and I recommend them to anyone who asks. They get an A++ rating in our book!
Evergreen Trails Campground
We couldn't be happier with Complete Payroll's service. Prompt and professional, every concern or question is addressed immediately. Our rep Lacy is an absolute pleasure to deal with. We have every intention to continue our working relationship with them for years to come. It is a load off to know that this part of our business is "worry free."
We have been in business for 70 years and have dealt with A LOT of other payroll companies! Complete Payroll is by far the best we have worked with! Ashlee Adams is my CSR and she is absolutely the BEST! Always makes time for me and very patient with any question that I may have!
We have been customers for many years. Evolution Software is easy to use but, more importantly, Cindy is an email away and her knowledgeable, efficient, and quick to replies to our questions are appreciated. We're very happy with Complete Payroll.
Chemung County SPCA
Complete Payroll is always there if we have a problem or need something special! Their response time is AWESOME!
Independent Title Agency, LLC
My CSR, Andi Dimmick, is The Bomb! She's always friendly, cheery, and with all her clients, makes me feel like she has carved time out for ME. Her customer service is AWESOME, and the personal touch means so much!
Explore What's Next
Everyone I talk to at CP is friendly and tries to help. If they don't have a ready answer, that's OK. They take the time to find one. Website is user friendly, too. The actual operation of payroll is dependable and reliable.
Peregrine Walton LLC
On the ball with pertinent payroll and HR topics - love the payroll system and customer service!
Mitchell T. Yencer
Things go quite smoothly and I have a very good rep: Megan!
GP Rochester, Inc.
Kari Sutton and her team always are there ready to help me with any questions or concerns. The reports are easy to read and complete with the data I need for the job! Thank you, Kari!
Cindy Van Buren
Great customer support and service!
KTS Management, Inc
Easy to use! My rep, Ashlee Adams gives great customer service, and I love the options you have while still being affordable.
Occupational Management Group
LeeAnn was very helpful, very thorough, patient, and professional, and pleasant! She is an excellent trainer!
Jack of All Trades
Leanne was very helpful!
JD Burkhardt, Inc.
LeeAnne was very helpful in explaining the program with me and answered all my questions. I look forward to trying it out on my own next week!
Attica Auto Supply Inc
Friendly, answered all my questions, and never felt hurried.
Nuttall Warehousing LLC
LeeAnn was just wonderful to work with.
Recent Articles from the Blog
We're constantly publishing content about payroll, human resources or anything related to managing your people.
Subscribe to Our Newsletter
Twice a month we share relevant and timely blog articles and other resources. No solicitations. No funny business. Just quality stuff to help employers.