In the FY 2025 SNF Prospective Payment System (PPS) Final Rule, the Centers for Medicare and Medicaid Services (CMS) finalized a policy for Skilled Nursing Facilities (SNFs) who participate in the SNF Quality Reporting Program a validation (i.e., audit) process beginning in the fall of 2025 for the FY 2027 SNF QRP. This process is a similar one adopted for the SNF Value-Based Purchasing Program. Key components of the validation program include:
- CMS’ contractor Healthcare Management Solutions, LLC (HMS) will randomly select up to 1,500 SNF each FY to submit MDS records for review.
- Selected SNFs will be notified through their iQIES MDS 3.0 Provider Preview Report folder.
- Selected SNFs are required to submit requested medical chart documentation to support validation of 10 MDS assessment records.
- Any selected SNF that fails to submit requested medical chart documentation within 45 calendar days of the audit notification will be considered noncompliant, resulting in the SNF losing 2% of Medicare reimbursement for the applicable fiscal year.
If after reviewing the available resources, you are still seeking additional information, you may contact the SNF Validation Help Desk at snfvalidation@hcmsllc.com.