Payroll-Based Journal (PBJ) FAQs

Get answers to the most frequently-asked questions about PBJ here. Got more questions? Submit them to our team at support@simpleltc.com.

PBJ general questions

What is the Payroll-Based Journal (PBJ)?

In accordance with Section 6106 of the Affordable Care Act (ACA), skilled nursing facilities are required to electronically submit staffing information to drive accountability and consistency in reporting throughout the industry. Total direct care hours worked, including agency and contract staff, must be included and auditable. This information will be used to report the level of staff (hours per patient day) and eventually employee tenure and turnover — all of which have been found to impact the level of care provided to residents.

To facilitate this effort, the Centers for Medicare and Medicaid Services (CMS) has developed a system for facilities to submit staffing and census information – Payroll-Based Journal (PBJ). This system will allow staffing information to be collected on a regular and more frequent basis than currently collected. It will also be auditable to ensure accuracy.

Note: Only long-term care facilities that are subject to meeting the Requirements for Participation as specified in 42 CFR Part 483, Subpart B are subject to the PBJ reporting requirements. This requirement does not apply to swing beds.

It’s critical for providers to get PBJ right.

CMS has stated that the electronic Payroll-Based Journal staffing information is a requirement of participation, and as such failure to submit - or reporting inaccurate data - can be costly, potentially leading to citation and civil money penalties.

CMS, along with major provider associations, have long identified staffing as a key component in delivering quality care and ultimately positive resident outcomes. So much so that CMS uses PBJ staffing information in the CMS Five-Star Quality Rating System, which then posts to the CMS Nursing Home Compare website, to help consumers and referral sources understand the level and differences of staffing in nursing homes when selecting a facility.

What is the goal of PBJ reporting?

The goal of the CMS Payroll-Based Journal (PBJ) is collect auditable data to track nursing home staffing levels and (eventually) employee turnover and tenure, which can impact the quality of care delivered.

To achieve this goal, CMS will:

Collect staffing and census data quarterly
Ensure the staffing data is accurate by requiring it comes from an auditable source
Standardize the staffing data that is collected

Who is subject to PBJ reporting requirements?

What are the CMS PBJ job title codes?

Job title codes identify the role a staff member has performed. Here is a full list of the 40 CMS PBJ Job Titles:

Labor Category Code	Job Title Code	Labor Description	Job Description	Description of Services
1	1	Administration Services	Administrator	Administrative staff responsible for facility management as required under 483.70(d) such as the administrator and the assistant administrator.
2	2	Physician Services	Medical Director	A physician designated as responsible for implementation of resident care policies and coordination of medical care in the facility in accordance with 483.70(h).
2	3	Physician Services	Other Physician	A salaried physician, other than the medical director, who supervises the care of residents when the attending physician is unavailable, and/or a physician(s) available to provide emergency services 24 hours a day.
2	4	Physician Services	Physician Assistant	A graduate of an accredited educational program for physician assistants who provides healthcare services typically performed by a physician, under the supervision of a physician.
3	5	Nursing Services	Registered Nurse Director of Nursing	Professional registered nurse(s) administratively responsible for managing and supervising nursing services within the facility. Do not additionally reflect these hours in any other category.
3	6	Nursing Services	Registered Nurse with Administrative Duties	Nurses (RN) who, as either a facility employee or contractor, perform the Resident Assessment Instrument function in the facility and do not perform direct care functions. Also include other RNs whose principal duties are spent conducting administrative functions. For example, the Assistant Director of Nursing is conducting educational/in-service.
3	7	Nursing Services	Registered Nurse	Those persons licensed to practice as registered nurses in the State where the facility is located. Includes geriatric nurse practitioners and clinical nurse specialists who primarily perform nursing, not physician-delegated tasks. Do not include Registered Nurses’ hours reported elsewhere.
3	8	Nursing Services	Licensed Practical/Vocational Nurse with Administrative Duties	Those persons licensed to practice as licensed practical/vocational nurses in the State where the facility is located, and do not perform direct care functions. Also include other nurses whose principal duties are spent conducting administrative functions. For example, the LPN Charge Nurse is conducting educational/in-service, or other duties which are not considered to be direct care giving.
3	9	Nursing Services	Licensed Practical/Vocational Nurse	Those persons licensed to practice as licensed practical/vocational nurses in the State where the facility is located. Do not include those hours of LPN/LVNs reported elsewhere.
3	10	Nursing Services	Certified Nurse Aide	Individuals who have completed a State approved training and competency evaluation program, or competency evaluation program approved by the State, or have been determined competent as provided in 483.150 and who are providing nursing or nursing-related services to residents. Do not include volunteers.
3	11	Nursing Services	Nurse Aide in Training	Individuals who are in the first 4 months of employment and who are receiving training in a State approved Nurse Aide training and competency evaluation program and are providing nursing or Nursing related services for which they have been trained and are under the supervision of a licensed or registered nurse. Do not include volunteers.
3	12	Nursing Services	Medication Aide/Technician	Individuals, other than a licensed professional, who fulfill the State requirement for approval to administer medications to residents.
2	13	Physician Services	Nurse Practitioner	A registered nurse with specialized graduate education who is licensed by the state to diagnose and treat illness, independently or as part of a healthcare team.
3	14	Nursing Services	Clinical Nurse Specialist	A registered nurse with specialized graduate education who provides advanced nursing care.
4	15	Pharmacy Services	Pharmacist	The licensed pharmacist(s) who a facility is required to use for various purposes, including providing consultation on pharmacy services, establishing a system of records of controlled drugs, overseeing records and reconciling controlled drugs, and/or performing a monthly drug regimen review for each resident.
5	16	Dietary Services	Dietitian	A person(s), employed full, part-time or on a consultant basis, who is either registered by the Commission of Dietetic Registration of the American Dietetic Association, or is qualified to be a dietitian on the basis of experience in identification of dietary needs, planning and implementation of dietary programs.
5	17	Dietary Services	Paid Feeding Assistant	Person who meets the requirements specified in C.F.R. Section 483.60(h)(1)(i) and 483.60(h)(1)(ii) and who is paid to feed residents by a facility, or who is used under an arrangement with another agency or organization. Paid feeding assistants can only feed residents who do not have complicated feeding problems that would require the training of a nurse or nurse aide. Paid feeding assistants must not feed any residents with complicated feeding problems or perform any other nursing or nursing-related tasks. A feeding assistant must work under the supervision of an RN or a LPN.
6	18	Therapeutic Services	Occupational Therapist	Persons licensed/registered as occupational therapists according to State law in the State in which the facility is located. Include OTs who spend less than 50 percent of their time as activities therapists.
6	19	Therapeutic Services	Occupational Therapy Assistant	Person(s) who, in accord with State law, have licenses/certification and specialized training to assist a licensed/certified/registered Occupational Therapist (OT) to carry out the OT's comprehensive plan of care, without the direct supervision of the therapist. Include OT Assistants who spend less than 50 percent of their time as Activities Therapists.
6	20	Therapeutic Services	Occupational Therapy Aide	Person(s) who have specialized training to assist an OT to carry out the OT's comprehensive plan of care under the direct supervision of the therapist, in accord with State law.
6	21	Therapeutic Services	Physical Therapist	Persons licensed/registered as physical therapists, according to State law where the facility is located.
6	22	Therapeutic Services	Physical Therapy Assistant	Person(s) who, in accord with State law, have licenses/certification and specialized training to assist a licensed/certified/registered Physical Therapist (PT) to carry out the PT's comprehensive plan of care, without the direct supervision of the PT.
6	23	Therapeutic Services	Physical Therapy Aide	Person(s) who have specialized training to assist a PT to carry out the PT's comprehensive plan of care under the direct supervision of the therapist, in accordance with State law.
6	24	Therapeutic Services	Respiratory Therapist	Persons(s) who are licensed under state law (except in Alaska) as respiratory therapists.
6	25	Therapeutic Services	Respiratory Therapy Technician	Person(s) who provide respiratory care under the direction of respiratory therapists and physicians
6	26	Therapeutic Services	Speech/Language Pathologist	Persons licensed/registered, according to State law where the facility is located, to provide speech therapy and related services (e.g., teaching a resident to swallow).
6	27	Therapeutic Services	Therapeutic Recreation Specialist	Person(s) who, in accordance with State law, are licensed/registered and are eligible for certification as a therapeutic recreation specialist by a recognized accrediting body.
6	28	Therapeutic Services	Qualified Activities Professional	Person(s) who meet the definition of activities professional at 483.24(c)(2)(i) and 483.24 (c)(2)(ii) (A) or (B) or (C) or (D) and who are providing an on-going program of activities designed to meet residents' interests and physical, mental or psychosocial needs. Do not include hours reported as Therapeutic Recreation Specialist, Occupational Therapist, OT Assistant, or other categories listed above.
6	29	Therapeutic Services	Other Activities Staff	Persons providing an on-going program of activities designed to meet residents' needs and interests. Do not include volunteers or hours reported elsewhere.
6	30	Therapeutic Services	Qualified Social Worker	Person licensed to practice social work in the State where the facility is located, or if licensure is not required, persons with a bachelor's degree in social work, a bachelor's degree in a human services field including but not limited to sociology, special education, rehabilitation counseling and psychology, and one year of supervised social work experience in a health care setting working directly with elderly individuals.
6	31	Therapeutic Services	Other Social Worker	Person(s) other than the qualified social worker who are involved in providing medical social services to residents. Do not include volunteers.
7	32	Dental Services	Dentist (NOT REQUIRED/OPTIONAL)	Persons licensed as dentists, according to State law where the facility is located, to provide routine and emergency dental services.
8	33	Podiatry Services	Podiatrist (NOT REQUIRED/OPTIONAL)	Persons licensed/registered as podiatrists, according to State law where the facility is located, to provide podiatric care.
9	34	Mental Health Services	Mental Health Service Worker	Staff (excluding those included under therapeutic services) who provide programs of services targeted to residents' mental, emotional, psychological, or psychiatric well-being and which are intended to: • Diagnose, describe, or evaluate a resident's mental or emotional status; • Prevent deviations from mental or emotional well-being from developing; or • Treat the resident according to a planned regimen to assist him/her in regaining, maintaining, or increasing emotional abilities to function. Among the specific services included are psychotherapy and counseling, and administration and monitoring of psychotropic medications targeted to a psychiatric diagnosis.
10	35	Vocational Services	Vocational Service Worker (NOT REQUIRED/OPTIONAL)	Evaluation and training aimed at assisting the resident to enter, re-enter, or maintain employment in the labor force, including training for jobs in integrated settings (i.e., those which have both disabled and nondisabled workers) as well as in special settings such as sheltered workshops.
11	36	Clinical Laboratory Services	Clinical Laboratory Service Worker (NOT REQUIRED/OPTIONAL)	Entities that provide laboratory services and are approved by Medicare as independent laboratories or hospitals.
12	37	Diagnostic X-ray Services	Diagnostic X-ray Service Worker (NOT REQUIRED/OPTIONAL)	Radiology services, ordered by a physician, for diagnosis of a disease or other medical condition.
13	38	Administration & Storage of Blood Services	Blood Service Worker (NOT REQUIRED/OPTIONAL)	Blood bank and transfusion services.
14	39	Housekeeping Services	Housekeeping Service Worker (NOT REQUIRED/OPTIONAL)	Services, including those of the maintenance department, necessary to maintain the environment. Includes equipment kept in a clean, safe, functioning and sanitary condition. Includes housekeeping services supervisor and facility engineer.
15	40	Other Services	Other Service Worker (NOT REQUIRED/OPTIONAL)	Record total hours worked for all personnel not already recorded (For example, librarian).

Can I create a PBJ XML file if I have staff hours by day in a spreadsheet?

What is the CMS Facility ID? Where do I find it?

When is the CMS PBJ reporting deadline?

The first mandatory reporting period began July 1, 2016. Submissions must be received by the end of the 45th calendar day (11:59 PM Eastern Standard Time) after the last day in each fiscal quarter to be considered timely.

Below are the deadlines for each reporting period:

FISCAL QUARTER	REPORTING PERIOD	DUE DATE
1	October 1–December 31	February 14
2	January 1–March 31	May 15
3	April 1–June 30	August 14
4	July 1–September 30	November 14

What is Nursing Home Compare?

Nursing Home Compare is a website managed by the Federal government that contains detailed information about every Medicare- and Medicaid-certified nursing home in the country. It contains quality of care and staffing information for all 15,000-plus Medicare- and Medicaid-participating nursing homes. The staffing data from the Payroll-Based Journal is used to calculate the Staffing Five-Star on Nursing Home Compare.

When do PBJ Staffing results post to Nursing Home Compare?

PBJ staffing hours

What are direct care staff?

Direct Care Staff are “those individuals who, through interpersonal contact with residents or resident care management, provide care and services to allow residents to attain or maintain the highest practicable physical, mental, and psychosocial well-being. Direct care staff does not include individuals whose primary duty is maintaining the physical environment of the long term care facility (for example, housekeeping).”

Can I report hours for contract staff who bill Medicare (or another entity) directly?

Can hours spent in new employee orientation be counted?

How should hours for exempt (salaried) staff be reported?

Can paid vacation and sick time hours be counted?

PBJ census

What do I report for census?

How does CMS calculate census?

“The daily resident census, used in the denominator of the reported nurse staffing ratios, is derived from MDS resident assessments and is calculated as follows:

Identify the reporting period (quarter) for which the census will be calculated (e.g., CY 2018 Q2: April 1–June 30, 2018).
Extract MDS assessment data for all residents of a facility beginning one year prior to the reporting period to identify all residents that may reside in the facility (i.e., any resident with an MDS assessment may still reside in the facility). For example, for the CY 2018 Q2 reporting period, extract MDS data from April 1, 2017 through June 30, 2018.
Identify discharged/deceased residents using the following criteria:
- If a resident has an MDS Discharge assessment or Death in Facility tracking record, use the date reported on that assessment and assume that the resident no longer resides in the facility as of the date of discharge/death on the last assessment. In the case of discharges, if there is a subsequent admission assessment, then assume that the resident re-entered the nursing home on the entry date indicated on the entry assessment.
- For any resident with an interval of 150 days or more with no assessments, assume the resident no longer resides in the facility as of the 150th day from the last assessment. (This assumption is based on the requirement for facilities to complete MDS assessments on all residents at least quarterly). If no assessment is present, assume the resident was discharged, but the facility did not transmit a Discharge assessment.

For any particular date, residents whose assessments do not meet the criteria in #3 above prior to that date are assumed to reside in the facility. The count of these residents is the census for that particular day.”

PBJ submission to CMS

How do I request access to the CMS PBJ?

In order to access the CMS Payroll-Based Journal you will require two accounts:

CMSNet User ID to access secure CMS sites. To request this account, visit CMSNet Online Registration.
QIES Submission ID to access the Payroll-Based Journal and CASPER Reporting websites. When you register for a CMSNet User ID, you will be emailed login information and instructions to connect to the “CMS Secure Access Service”. Once securely connected, select the “CMS QIES Systems for Providers” link to access the QIES online “User Registration” tool. New users must utilize the online “User Registration” tool to obtain a QIES Submission login ID (with the exception of Corporate/Third-Party accounts).

For more information, visit https://qtso.cms.gov/access-forms/pbj-individual-access.

How do I log into the CMS PBJ?

Logging into the CMS Payroll-Based Journal is a multi-step process:

Go to the QTSO submission access page. Click on your state and follow the prompts.
Enter your CMS Secure Access Service account username and password. This will connect you to the CMS network allowing you access to their secure sites (including PBJ).
The QIES System webpage will be displayed. Click the PBJ Submissions link.
Enter your PBJ user ID and password. This is a different account than you used for CMS Secure Access Service.

How do I upload a CMS PBJ XML file?

Uploading a CMS PBJ XML file is a multi-step process:

Make sure your zipped XML is in a local folder since the CMS Secure Access Service will disconnect network drives.
Connect to the CMS Secure Access Service and then navigate to the PBJ system (more info above).
Once you’re in the PBJ system, click the Upload Data File menu item.
Select the Federal Fiscal Quarter. Make sure you select the Federal Fiscal Quarter and not the regular calendar quarter.
Click Browse… and select your zipped XML file.
Click the Upload File
Write down or print the Submission ID.
Review the PBJ Final File Validation Report from the CASPER reporting system.

How can I simplify the submission of my PBJ file?

COVID-19 and PBJ

Do I need to submit January-March 2020 PBJ data?

How will my star rating be calculated for Q2 (January-March) 2020?

Can we count hours paid for with PPP money?

Can we include hours for physicians, pharmacists, dietitians, etc. who are working remotely or via telehealth?

How do you code MDS RN and LPN staff who are working remotely?

CMS issued certain blanket waivers affecting skilled nursing facilities that may experience staffing issues due to COVID-19. Due to staff shortages, some facilities relied on nursing assistants and home health aides to provide patient care. Can these hours be included for PBJ reporting?

Instead of having to get all of the training and certification done as a CNA within four months of being hired, CMS relaxed this – and the same with the in-service training requirement that would need to have been done. If individuals hired under the waiver provided certified nurse aide care at your facility, you may NOT include the hours as a Certified Nurse Aide (PBJ Job Title 10). You may – if you want to include the individuals – claim them as a Nurse Aide in Training (PBJ Job Title 11). Reread the relaxed parameters listed by CMS in the waiver to ensure that the individuals you’re temporarily assigning as CNA adhere to the relaxed rules: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf.

We had licensed nurses working as CNAs during isolation for COVID-19. Do we report them as licensed nurses or CNAs?

If a LPN works as a CNA, it should be recorded as a CNA – but if a CNA works as a LPN, they would still be reported as a CNA?

With the waiver, can we hire LPNs with a provisional license? If so, what would their coding be for PBJ?

Are we allowed to include temporary National Guard CNA/RN/EMT in PBJ if we have not yet paid for their services?

We had certified nurse assistant students working when short-staffed during isolation period. If we didn’t pay them, is there any way to record their hours for PBJ?

During the pandemic, can hours worked by therapists or therapist assistants covering CNA shifts be counted in PBJ time?

What will happen to temporary CNAs after the pandemic? Will temporary nurse aides who did an online 8-hour course and performed their skills at the facility at which they work be able to sit for state exams and be classified as CNAs eventually? Will the temporary CNA hours count as the clinical hours needed to take the state exam?

Get help with your PBJ

Assemble, validate and submit PBJ reports, and predict your Staffing Five-Star with SimplePBJ™

Get started now