Why is it important for long-term care and skilled nursing facilities to master the payroll-based journal (PBJ) reporting?
If facilities make a mistake in filling out the report or miss a deadline, there are consequences, like receiving a one-star rating in the Nursing Home Five-Star Quality Rating System, which can reduce the number of potential residents considering the facility.
But hey, don’t worry! This article can clarify any PBJ reporting doubts and help you avoid common PBJ pitfalls.
What is Payroll-Based Journal reporting?
Payroll-Based Journal reporting is a system developed by the Centers for Medicare & Medicaid Services (CMS) requiring long-term care facilities to submit staffing and payroll figures. This information tracks the time worked by nursing staff to evaluate how well long-term care facilities match their staffing levels to patient care demand.
When combined with census information, this data helps the CMS measure the impact of turnover on patient care.
Facility staffing is a key factor in providing quality patient care. As such, the CMS developed the payroll-based journal system in 2016 and, more recently, issued a staffing mandate in 2024.
The Affordable Care Act, section 6106, mandates that long-term care facilities submit direct care staffing information electronically on a set schedule. This requirement includes data regarding agency and contract staff in addition to W-2 employees.
What is Payroll-Based Journal reporting used for?
The PBJ staffing data is used for the following:
- Provides transparency in a uniform format for a facility to report its staffing levels
- Collects data and measures whether long-term care facilities meet quality standards
- Qualifies facilities for the five-star CMS rating system
- Allows for the identification of understaffed areas in a facility
- Identifies possible problems in healthcare outcomes
What staffing categories need to be reported?
Long-term care facilities need to report details regarding various nursing and non-nursing staff members. Payroll-Based Journal reporting requirements apply for the following categories of healthcare professionals:
Direct-care staff
- Registered nurses (RNs)
- Licensed practical/vocational nurses (LPNs/LVNs)
- Certified nursing assistant (CNAs)
- Therapists
- Medical personnel specified by the CMS
Contract/agency staff
- Temporary RNs, LPNs/LVNs, CNAs
- Contract therapists
Not required to report
- Administrative staff (not providing direct care)
- Maintenance and housekeeping staff
- Non-care related roles
Adequate staffing rates and PBJ are closely related to obtaining a five-star CMS rating. Therefore, long-term care facilities that want to improve staffing efficiency and increase or maintain their CMS rating can rely on PRN staffing platforms like Nursa that provide access to local healthcare workers who can fill schedule gaps.
Nursa is an excellent way to avoid agency fees and reduce overtime. Proper staffing levels also help maintain adequate hours per patient day and provide quality care.
What facilities need to submit their PBJ?
The CMS requires that long-term care facilities submit the PBJ. These facilities include nursing homes, rehabilitation centers, and skilled nursing facilities that are part of Medicare and Medicaid.
Required information and format
Are you wondering how to submit PBJ data?
Use one of the following formats when submitting:
- Manual data entry
- Upload a preformatted XML file
Here are the information categories required.
Census
This is the one information category that cannot be manually entered. The CMS calculates the resident census using information from the Minimum Data Set (MDS) assessment, a standardized evaluation of the health status of nursing home residents.
Pay Type Code
There are three types of code classifications by staff category:
- Exempt
- Non-exempt
- Contract
Hours
Long-term care facilities must report the number of hours worked by each employee, including agency and contract workers. Meal breaks or paid hours for any type of leave should not be counted.
Work Date
The hours per day need to be reported by calendar day. It is important to know that each day reported ends at midnight.
For example, if a nurse starts their shift at 9 p.m. on Monday and finishes at 7 a.m. on Tuesday, three hours will be recorded for Monday and seven hours for Tuesday.
Employee ID
Every staff member must have an employee ID number, which is a unique identifier. Any personal information, such as names, is not required.
The ID number should be used only by one employee for the duration of their employment. However, in some cases, an ID number can be reused when an internal staff member leaves the facility.
The IDs are used to measure turnover rates. For that reason, facilities must try to maintain the IDs even if they switch submission methods. If not possible, facilities must link the old IDs with the new ones to maintain reporting hours for the same employee.
PBJ submission deadlines
Direct care staffing information must be submitted each fiscal quarter. In order to be considered on time, the reporting must be sent by the end of the 45th calendar day ET, after the last day of the quarter.
These are the CMS’s PBJ reporting deadlines:
Payroll-Based Journal job codes
The CMS has 40 job codes and labor categories for the PBJ. The data is based on the employee’s primary role and title. Here are a couple of examples:
- The labor category code three, with the job title code seven, refers to registered nurses.
- The labor category code three, with the job title code nine, refers to licensed practical/vocational nurses.
Refer to the CMS’s Electronic Staffing Data Submission Payroll-Based Journal: Long-Term Care Facility Policy Manual for the total list of codes.
5 PBJ reporting pitfalls to avoid
Implementing compliance best practices is important to avoid pitfalls and possible PBJ audits. This ensures that all PBJ requirements are met and that the information submitted is error-free.
The following are five reporting pitfalls to avoid.
1. Missing or incomplete staffing hours
Reporting incomplete or missing hours may result in incorrect staffing data collection and could negatively affect the facility’s rating on the CMS star system.
To avoid this pitfall, facilities can do the following:
- Implement automated timekeeping systems.
- Compare staffing hours reports with payroll hours to find differences.
- Cross-check schedules with clock-in/out data.
2. Attributing overnight shifts to the wrong days
When submitting hours worked for the PBJ, it is crucial to count only the hours until midnight of each day. Therefore, recording hours correctly for overnight shifts is critical.
Use a timekeeping system that splits midnight shifts and reports hours per calendar day, and spot-check monthly overnight logs.
3. Failing to submit on time
Facilities must upload the PBJ by the deadlines outlined in this article. Late submissions can negatively affect a facility's five-star rating.
4. Reporting incorrectly for exempt staff
One common pitfall is healthcare facilities failing to report actual hours worked for staff in the exempt category, like directors of nursing.
Although exempt employees are not entitled to overtime pay, facilities must report the actual hours worked, not only the scheduled hours.
To avoid this pitfall, facilities can require their exempt employees to log their in/out time or self-report weekly, avoid flat-hour entries (e.g., always entering 40 hours/week), and conduct monthly manager hour audits.
5. Forgetting to check the submitted PBJ data
Ensure the submitted data is accurate and complete.
Users can create a pre-submission checklist, save all data backlogs for documentation, and designate an independent reviewer to verify accuracy.
Use PBJ reporting to your advantage
PBJ reporting may require considerable attention and time. However, it is an opportunity for long-term facilities to improve staffing efficiency, identify areas for improvement, and implement necessary policies to provide quality care.
The main goal of the PBJ is to standardize the quality-of-care metrics for long-term facilities. Therefore, it is beneficial not only for facilities but also for the residents, and it ultimately enhances care throughout the country.
Long-term care facility managers need to change their mindsets and look for out-of-the-box solutions to improve staffing efficiency, saving time to focus on properly filling out the PBJ.
Flexible, transparent, and on-demand staffing solutions are required to meet the demand for nurses and nursing assistants in long-term care facilities. Here is where Nursa shines.
Nursa is a PRN healthcare staffing platform where facilities have control over the contracting process, don't need to pay expensive hire-away fees, and can access a broad pool of talented clinicians ready to work.
Need to fill a weekend call-out or respond to sudden increases in patient census? Explore how Nursa can help long-term care facilities find qualified nursing talent.
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