CMS Plans Offsite MDS Audits of Schizophrenia

Providers brace for schizophrenia MDS audits; potential for Five-Star rating downgrades and Quality Measure (QM) rating suppression penalties.

CMS released memo QSO-23-05-NH, addressing QM ratings based on erroneous schizophrenia coding and processes for posting citations under dispute.CMS has identified a trend of MDS coding residents as having schizophrenia, without supportive documentation. The Five-Star QM percentage of long-stay residents who are receiving antipsychotic drugs will be inaccurate if schizophrenia is incorrectly coded. The memo details actions CMS will take to address this trend:

  • CMS will begin conducting offsite audits to assess the accuracy of MDSs for residents with a diagnosis of schizophrenia.
  • CMS will adjust QM star ratings for facilities identified through schizophrenia MDS audits to have coding inaccuracies:
    • Overall QM and long-stay QM ratings downgraded to 1 Star for 6 months (facility’s overall star rating will drop by 1 star as a result)
    • Short-stay QM rating suppressed for 6 months
    • Long-stay antipsychotic QM suppressed for 12 months
  • Facilities selected for an audit will have the opportunity to forego the audit by admitting, prior to the start of the audit, to errors and committing to correct the issue. CMS will consider lesser penalties for facilities admitting to miscoding, i.e., suppression of QM ratings rather than downgrade.

Also in the memo, CMS will begin to display citations under Informal Dispute Resolution (IDR) and Independent IDR (IIDR) on Nursing Home Care Compare, with a note that citations are under dispute.

Celtic reminds facilities the importance of accurately coding Diagnosis in Section I of the MDS. We are available to conduct a detailed audit for compliance with coding schizophrenia on the MDS.

Let’s discuss how we can help you prepare for CMS’s schizophrenia MDS audits and avoid Star Rating and QM declines.

About Lauren Videtto