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Five-Star Rating Schizophrenia and Dispute CMS Memo 1.18.2023

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Five-Star Rating Schizophrenia and Dispute CMS Memo 1.18.2023

Please see the attached 1.18.2023 CMS Memo.

View the 1.18.23 CMS Memo 

 

QSO Updates to the Nursing Home Care Compare Website and Five Star Quality Rating System.

 

Adjusting Quality Measure Ratings Based Upon:

 

  • Erroneous Schizophrenia Coding, and

  • Posting Citations Under Dispute.
  • Erroneous Schizophrenia Coding (Adjusting Quality Measure Ratings)

 

  • CMS will be conducting audits of schizophrenia coding in the Minimum Data Set data and based upon the results, adjust the Nursing Home Care Compare quality measure star ratings for facilities whose audits reveal inaccurate coding.

 

  • Facilities selected for an audit 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, at the conclusion of the audit, the facility will have the opportunity to discuss the audit results with CMS.

 

Facilities that have coding inaccuracies identified by the Schizophrenia MDS audit will have their Quality Measure Ratings adjusted as follows:

 

  • The Overall Quality Measure and Long Stay Quality Measure Ratings will be downgraded to one star for six months (this drops the facility’s overall star rating by one star).
  • The Short Stay Quality Measure rating will be suppressed for six months.
  • The Long Stay Antipsychotic Quality Measure will be suppressed for 12 months.

 

2.) Posting Citations Under Dispute

 

To be more transparent, CMS will now display citations under informal dispute on the Nursing Home Care Compare website.

 

  • While the citations will be publicly displayed, CMS will not include them in the calculation of a facility’s star rating until the dispute is complete (and the survey is considered final).

 

  • In order to be consistent in how citations are reported across different platforms, CMS will also include citations under IDR/IIDR on the QCOR website.

 

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Topics: CMS, MDS, MDS Coding, Regulatory


Kris Mastrangelo, OTR/L, LNHA, MBA

WRITTEN BY

Kris Mastrangelo, OTR/L, LNHA, MBA
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