Most nursing home administrators treat payroll and staffing data as two separate jobs. For CMS they aren't. Long-term care facilities submit staffing hours every quarter through the Payroll-Based Journal, and that data is built from payroll records. It feeds the staffing measures families see on Care Compare. A payroll mistake doesn't stay in payroll.

The problems tend to be dull ones. Employees coded to the wrong job category, a med aide sitting under CNA or the reverse, because the title in the payroll system never got updated. Agency and contract hours missing entirely because those workers don't run through payroll and nobody pulled their hours from the invoices. A DON who works a nursing shift on the floor with every hour reported as administrative. Salaried employees whose hours were never recorded because they don't clock in.

Each of these moves reported staffing in a direction the facility didn't intend, and CMS can ask for supporting records.

A reconciliation before each submission closes most of it. Pull hours by job category from payroll, add contract hours from agency invoices, and compare the total to the PBJ file and to what the schedules say actually happened. If the numbers are off by more than rounding, find out why before the deadline, not after. Give one person ownership of the job title mapping and route every new hire and title change through them.

Nursing payroll has its own overtime wrinkle as well. Under the FLSA, hospitals and residential care establishments can use an "8 and 80" system, paying overtime on hours beyond 8 in a day and beyond 80 in a 14-day period instead of the usual 40 in a week. It requires an agreement with the employee before the work is done and records that match, and plenty of facilities run it out of habit without the paperwork. Shift differentials, on-call pay, and PRN staff covering other units add more ways to get a paycheck wrong, and a wrong paycheck is a quick route to losing an aide to the facility down the road.

If payroll in your building is handled by whoever has the most time, price out a team that owns both the pay run and the reporting trail. LTCPro's payroll management for long-term care facilities is built around that.

Author bio: Written by the LTCPro team. Learn more about LTCPro, a US-based partner handling payroll, billing, and accounting for skilled nursing and assisted living facilities.