The Centers for Medicare & Medicaid Services (CMS) has issued Memo QSO-25-14-NH, “Revised Long-Term Care (LTC) Surveyor Guidance: Significant revisions to enhance the quality and oversight of the LTC survey process,” with an effective date of April 28, 2025. One key revision pertains to the admission, transfer, and discharge agreement. In the memo, CMS clarified guidance prohibiting admission agreements from containing language that requests or requires a third-party guarantee of payment, adding examples of non-compliance.
Our latest whitepaper provides essential insights on how Unified Program Integrity Contractors (UPICs) operate and the potential risks they pose to healthcare providers. In this whitepaper, you’ll learn: The role of UPICs in fraud detection for Medicare & Medicaid. How UPICs conduct audits and investigations. Critical strategies for managing UPIC audits and appeals effectively. Key insights into the appeals process and how to maximize your chances of success. Don’t let a UPIC audit catch you
New Surveyor Guidance is in effect and indicates that mental health disorders in nursing home facilities need to be diagnosed by a medical practitioner. Evidence-based criteria and professional standards, such as the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), must be used and supported by documentation in the resident’s medical record. Diagnoses such as Schizophrenia and schizoaffective disorder require supporting documentation such as a DSM assessment, like all other mental
