For skilled nursing and long-term care
Scheduling built around the survey, the census, and the agency bill
Long-term care scheduling software staffs a skilled-nursing facility to its census and acuity rather than to a headcount, tracks hours per resident day, keeps every licence and exclusion check survey-ready, and produces the quarterly CMS Payroll-Based Journal submission from hours already captured in the schedule.
From $99/month per location · No sales call · No card to start
At a glance
- CMS requires skilled-nursing facilities to submit staffing hours by job code quarterly through the Payroll-Based Journal (PBJ). It is the most common reason an SNF buys scheduling software.
- MedAligna generates PBJ from hours already captured in the schedule and timesheets, rather than from a spreadsheet rebuilt the week it is due.
- HPRD, hours per resident day, is computed continuously from the same data as your ratio compliance, not reconstructed quarterly.
- Acuity weighting on census means required staffing reflects the care residents actually need, not a flat headcount.
- Agency is typically 10–30% of nursing hours at a 30–45% markup. The fill waterfall exhausts your own staff, per-diem pool and sister facilities first, and shows what that avoided.
Does it generate the CMS PBJ file?
PBJ, generated rather than re-keyed. The Payroll-Based Journal is the single reason most skilled-nursing facilities buy scheduling software at all, and it is usually the last thing the software actually does.
It does, from the hours you already captured. CMS requires quarterly submission of nursing hours by job code, and MedAligna produces the file from clock-ins, approved timesheets and job codes mapped to positions, rather than from a spreadsheet reconstructed the week it is due. Hours per resident day is computed from the same data, against the same census you entered to check your ratios.
Which means the quarterly panic becomes a download. It also means the number you file is the number your schedule actually says, which is a better position to be in than the alternative.
How does acuity-based staffing work?
Acuity, because residents are not interchangeable. Staffing to a headcount is how a facility ends up correctly staffed on paper and short on the floor.
Census entries carry an acuity multiplier, so required staffing reflects how much care the residents in front of you actually need. The coverage row turns red the day a shift falls short, not at the end of the month, when the period is closed and nobody can do anything about it.
Federal exclusion screening runs against every staff member, because employing an excluded individual costs the facility a civil monetary penalty for every item that person touches. Licences, TB, immunisations, background checks and abuse-registry checks are tracked with documents attached and expiry alerts at sixty, thirty, fourteen and seven days.
How do you stop paying agency for shifts your own staff could cover?
The agency bill is the biggest number you control. Ten to thirty per cent of a facility's nursing hours often come from agency, at a markup of thirty to forty-five per cent, and most of it is coverable internally.
MedAligna escalates every open shift through your own staff, then your per-diem pool, then your sister facilities, and only then to agency. And it shows you what that avoided. Agency staff are costed at their bill rate, so the true cost of a gap is on the screen while the decision is being made rather than on an invoice a month later.
Low-census call-offs work the same way in reverse, with a fairness counter that answers the question every DON is asked on a light morning: who got flexed last.
What changes for a facility, quarter by quarter?
The quarter that is due Friday
PBJ is due. Three months of hours live in timesheets, a payroll export, and the DON's memory. Somebody spends two days rebuilding it and hopes the numbers hold.
The file is generated from hours already captured, with positions mapped to CMS job codes. The number you file is the number your schedule says.
The low-census morning
Census is down. Someone has to be flexed off. The DON is asked the question she is always asked: who got sent home last time?
Call-offs carry a reason and feed a fairness counter, so the answer is a record rather than a recollection, and the nurse who was flexed twice running is not flexed a third time.
The agency invoice
The month's agency spend arrives. Nobody can say which of those shifts could have been filled internally, because nobody was ever shown the alternative at the time.
Every fill is recorded with the tier it came from and the agency cost it avoided. The monthly question finally has an answer that is not a guess.
How to choose long-term care scheduling software
Eight questions worth asking any vendor in this category, including us. At least one of them is a question we do not answer well, and we have said so rather than leaving it out.
01Does it actually generate the PBJ file, or just 'support PBJ'?
There is a large difference between producing a submittable file from your real hours and exporting a spreadsheet that somebody then has to reshape. Ask to see the output.
Where MedAligna lands: Generates the quarterly PBJ XML from hours captured in MedAligna, with positions mapped to CMS job codes.
02Is HPRD computed continuously or quarterly?
A staffing measure you only see after the period has closed is a report, not a control. By then nobody can change anything.
Where MedAligna lands: Computed continuously from approved hours and the census you already enter for ratio compliance.
03Does it screen against the OIG exclusion list?
Employing an excluded individual while billing Medicare or Medicaid carries civil monetary penalties per item or service. For an SNF this is not a theoretical exposure.
Where MedAligna lands: Screened per staff member with a monthly re-screen interval. A confirmed exclusion blocks scheduling; a possible match blocks it until a human resolves the name collision.
04Can it staff to acuity, not just headcount?
Residents are not interchangeable units of work, and a facility staffed correctly on paper can be badly short on the floor.
Where MedAligna lands: Census entries carry an acuity multiplier that drives required staffing.
05Will it help you see and reduce agency spend?
It is usually the largest controllable line in the labour budget, and most tools are silent on it because they cannot tell an agency nurse from an employee.
Where MedAligna lands: Agency staff carry a bill rate, sit last in the fill order by policy, and the spend avoided by filling internally is shown as a number.
06Does it integrate with PointClickCare?
For many SNFs, the clinical system is PointClickCare, and census flowing automatically is genuinely valuable.
Where MedAligna lands: We do not have a PointClickCare integration today. Census is entered in MedAligna, and hours export to payroll and PBJ. If a live clinical feed is a requirement, that is a real gap and we would rather you heard it from us.
What is PBJ, HPRD, or an acuity multiplier?
- PBJ
- Payroll-Based Journal. The quarterly submission CMS requires from skilled-nursing facilities, reporting nursing hours by job code, used to calculate staffing measures that feed public star ratings.
- HPRD
- Hours per resident day. It is calculated by dividing the nursing hours worked in a day by the number of residents that day: 270 nursing hours across a census of 90 is 3.0 HPRD. Reported to CMS quarterly through the Payroll-Based Journal, and used as a headline staffing measure, which is why the hours feeding it have to be real elapsed hours, not scheduled ones.
- Acuity multiplier
- A weighting applied to census so that required staffing reflects the level of care residents actually need rather than the number of beds occupied.
- Low-census call-off
- Cancelling a scheduled nurse because the resident count is lower than planned. Legitimate, and a source of real resentment unless it is tracked fairly.
- Job code
- The CMS classification of a staff member's role for PBJ reporting. Mapping positions to job codes correctly is the difference between a clean submission and a rejected one.
- Abuse registry check
- A state-level screening required for staff in long-term care, alongside licensure and background checks. Recorded in MedAligna as a result the employer obtained: we store outcomes, we do not order checks.
Questions people actually ask
- What is long-term care scheduling software?
- Long-term care scheduling software staffs a skilled-nursing facility to its census and acuity rather than to a headcount. It tracks hours per resident day, keeps licences, immunisations and federal exclusion checks survey-ready, and produces the quarterly CMS Payroll-Based Journal submission from hours already captured in the schedule. A general shift planner does none of these: it can put a name in a box, but it cannot tell you the facility was under its HPRD on the fourteenth, and it cannot file the quarter.
- What does long-term care scheduling software cost?
- MedAligna is $149 per month per location for the tier that matters here: PBJ export, HPRD, ratio and acuity compliance, and time and attendance all sit on Pro. Starter is $99 if you only need the roster, credential blocking, exclusion screening and the staff app. Enterprise is $249 for unlimited staff and an API. Three or more facilities get 20% off, and the trial is 14 days without a card.
- Who sets it up, and what does the facility need to provide?
- The DON or the scheduler does it, and the facility provides three things: a staff list to import from CSV, the positions mapped to CMS job codes, and the census. The mapping is the part worth doing carefully (it is what a clean PBJ submission turns on), and it is done once. There is no implementation project, no consultant, and no sales call before you can use the product; the trial is the whole thing.
- Does it produce the CMS PBJ file?
- Yes: the quarterly Payroll-Based Journal XML, generated from hours already captured in MedAligna, with positions mapped to CMS job codes. No re-keying from a spreadsheet the week it is due.
- Does it calculate HPRD?
- Yes. Hours per resident day is computed from your approved hours and the census you already enter for ratio compliance, so it is available continuously rather than reconstructed quarterly.
- Can it handle acuity-based staffing?
- Yes. Census entries carry an acuity multiplier, so required staffing reflects the care the residents actually need rather than a flat headcount.
- Does it screen against the OIG exclusion list?
- Yes. Federal exclusion screening is tracked per staff member with a re-screen interval, and a confirmed exclusion blocks scheduling outright. A possible match blocks scheduling until a human resolves it: names on the public list collide, and that adjudication belongs to you, not to software.
- Will it help with agency spend?
- It escalates every open shift through your own staff, per-diem pool and sister facilities before suggesting an agency, costs agency staff at their bill rate, and shows what filling internally avoided. That is where the money is.
- Does it work for assisted living and memory care?
- Yes. Assisted living scheduling is the same job minus the federal reporting: credential blocking, exclusion screening, acuity-weighted coverage and the staff app all apply, and the PBJ machinery simply stays switched off because assisted living communities are not required to file it. A campus running skilled nursing and assisted living side by side schedules both as locations of one organisation.
Related
Make the next survey boring
PBJ from real hours, HPRD continuously, exclusions screened, and an agency bill you can finally see.