There is so much going on in the Long Term Care (LTC) market in 2024 related to Centers for Medicare and Medicaid (CMS) initiatives it is easy to overlook one or think that it is complete.  This might be the case with the CMS roll out of audits to monitor accurate coding and documentation of the diagnosis of schizophrenia. CMS initiated these audits, announced on January 18, 2023, in QSO-23-05-NH, in an attempt to identify instances of erroneous coding and diagnosing of schizophrenia for the assumed purpose of justifying antipsychotic usage.

Nursing homes identified to have erroneously coded schizophrenia on the MDS are being penalized through the Quality Measures domain on Nursing Home Care Compare. Nursing homes that “fail” the audit, meaning the schizophrenia diagnoses could not be verified, are have their ratings adjusted as follows:

  • Overall Quality Measure domain rating and long stay Quality Measure ratings will be downgraded to one star for 6 months. This will result in the nursing home’s overall Five Star Quality Rating being downgraded by one star.
  • The short stay Quality Measure ratings will be suppressed for 6 months.
  • The long stay antipsychotic measure will be suppressed for 12 months.

Nursing homes that choose to forego an audit and attest to coding errors will receive lesser penalties on Nursing Home Care Compare.

Fast forward to February 2024; it has been a year since CMS announced the schizophrenia audit initiative. If your SNF did not receive a request for a schizophrenia audit, you might think that you are free and clear. However, according to a recent article published in the McKnight’s Long Term Care News on January 19, 2024, CMS is not finished with the audits!

If you have residents in your facility that have coding of schizophrenia on the Minimum Data Set (MDS) in Section I, and you have not yet received a request from CMS for a schizophrenia audit, you may want to consider reading the LWCI white paper on Schizophrenia as preparation.

Please contact Kay Hashagen, PT, MBA, RAC-CT to discuss by emailing [email protected] or by phone at (410) 777-5999.