Quality Indicator Survey - QIS


Quality Indicator Survey is a computer assisted long term care survey process used by selected State Survey Agencies and CMS to determine if Medicare and Medicaid certified nursing homes meet federal guidelines for nursing home care.

  • The QIS is a two-staged process used by surveyors to systematically review specific nursing home requirements and objectively investigate any regulatory areas that are triggered.  
  • Although the survey process has been revised under the QIS, the federal regulations and interpretive guidance remain unchanged. 

The QIS survey process begins with off-site survey preparation activities, including review of prior deficiencies, current complaints, ombudsman information, existing waivers/variances (if applicable), and importing Minimum Data Set (MDS) information to the surveyors laptop computers.

The QIS survey is split into Stage 1 and Stage 2 process. 

Stage 1 provides the opportunity for an initial review of large samples of residents which includes interviews (resident, family and staff), resident observations, and clinical record reviews.  The information gathered in this process is entered into the laptop computer, and the specialized software will calculate the results of this preliminary exploratory process.  Mandatory facility tasks, including resident council interview, observations of dining and kitchen areas, infection control process, and medication administration, as well as a review of the Medicare demand billing process and the quality assurance program, are completed.

Once the Stage 1 review is completed the specialized software will use the surveyors’ findings and the MDS data to determine which Quality of Care and Life Indicators (QCLIs) have exceeded threshold and consequently trigger care areas and/or non-mandatory facility tasks for further investigation in Stage 2 of the survey.

Stage 2 of the QIS survey will include an in-depth care area investigation using a set of investigative protocols that assist surveyors in completing an organized and systematic review of the triggered care area, as well as completion of all mandatory tasks and completion of triggered non-mandatory tasks.  Triggered non-mandatory tasks include abuse prevention, environment, nursing services, sufficient staffing, personal funds, and admission, transfer and discharge.

After all investigations have been completed the team analyzes the results to determine whether noncompliance with the federal regulations exists.  The specialized software uses the information gathered in investigation and applies the same decision making process to determine noncompliance as is used in traditional survey, including scope and severity.  An exit conference is conducted, during which the nursing home is informed of the survey findings.

Potential Risks to Providers:

  • The annual survey is closely linked to clinical and financial success of the facility, as well as continued certification for participation in Medicare and Medicaid.  
  • Survey preparation and completion of the Plan of Correction (POC) are critical components of compliance.
  • Although the State Operations Manual (SOM) and interpretive guidelines have not changed with the implementation of QIS, the process of survey has changed greatly and facilities must be familiar with the new process to be successful.

How can Harmony Healthcare International (HHI) help?

Based on cumulative years of expert knowledge and experience with annual State Survey, HHI has developed its own unique, comprehensive Mock Survey Process that provides the opportunity for the facility to:

  • Proactively identify specific areas in which the facility would be vulnerable to citation during annual survey
  • Assist the facility to create a “plan of correction” for identified issues in order to increase compliance prior to the annual survey
  • Determine key educational opportunities for the clinical staff and provide in-service education relating to the findings of the Mock Survey

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