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Will Your NH Survive A Random CMS Audit: A review of QSO-23-05-NH

Will Your NH Survive A Random CMS Audit: A review of QSO-23-05-NH

CMS has done it again. on Jan 18, 23, CMS released their most recent QSO, QSO-23-05-NH.

The focus of this QSO is on the following.

  1. Auditing NH MDS files to check for erroneous coding of the Schizophrenia DX. The audits can result in an adjustment of your five-star quality scores
  2. Posting Citations Under Dispute: CMS aims to be more transparent & will now display citations under informal dispute on the Nursing Home Care Compare website.

What does this mean for your nursing facility?


Erroneous Coding:


Facilities will be selected for an audit at random. The chosen facilities will receive a letter explaining the purpose of the audit, the process that will be utilized, and instructions for providing supporting documentation. During the audit process, facilities will have the opportunity to ask questions and seek any clarification needed. Additionally, the facility will have a chance to discuss the audit results with CMS after the audit. If incorrect coding is captured on the MDS, your facility's long-stay star metric will be downgraded.

The good news is that you can self-report your coding inaccuracies before being selected randomly for an audit. If your self-report, CMS may consider a lesser action related to your star ratings.


IDR/IDDR & Nursing Home Compare:

Any citation you receive will be posted on CMS Compare before your IDR/IDDR results. CMS will post deficiency citations under the IDR/IIDR section of Nursing Home Care Compare. CMS will display citations and will indicate that the citation is under dispute. While the citation you are disputing is working through the IDR/IDDR process, your facility star levels will only be impacted once the dispute results are issued.


Consequences of failing CMS Schizophrenia random audit.

CMS will do the following if you have coded incorrectly

  1. Your overall QM and long-stay QM ratings will be downgraded to one star for six months (this drops the facility's overall star rating by one star).
  2. Your short-stay QM rating will be suppressed for six months. •
  3. Your long-stay antipsychotic QM will be suppressed for 12 months.

How does this impact your facility?

  1. The decrease in star levels can negatively impact your facility's revenue.
  2. Your facility is at risk for the following F tag violation

      a.              F658: Services Provided Meet Professional Standards

      b.              F740: Behavioral Health Services

      c.              F758: Free from unnecessary Psychotropic Meds/PRN Use

  1. Your facility may be at risk for increased surveys based on the audit results.

How can SMK help you prepare for the new changes?


SMK Medical is a full-service healthcare consulting firm. We have RAC-CT & RAC-CTA certified MDS nurses who can perform a rapid risk assessment for your facility. Our rapid risk assessment can be conducted virtually to ensure we do not disrupt your facility operations. Based on our evaluation, we can provide you with realistic five-star feedback.

SMK Medical can also handle your IDR/IDDR needs. Take the stress off your leadership team by utilizing SMK Medical team of experts to handle your IDR/IDDR. With over 70% of IDR/IDDR being rejected, you need a team of experts with a proven track record to help you win.


Let SMK Medical help you avoid citations and beat IDR/IDDRs.



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Prepare for the 🤔 possible star reduction 👩‍🏫 with this excellent summary of QSO-23-NH. Over 70% of IDR and IDDR fail 😱 Do you have any strategies to beat an IDR/IDDR? How are you preparing for a possible star reduction? What do you think of QSO-23-NH? 

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