My facility has been selected for a Schizophrenia Audit by CMS. How will the results of this audit impact our facility’s Five Star rating?




Inaccuracies identified through these audits impact QM ratings as follows:

      • The overall QM and long-stay QM ratings are downgraded to one star for six months, which will result in a decrease in the facility’s overall star rating by one star. The facility will also receive the minimum number of points for the long-stay antipsychotic QM for 7-12 months. The short-stay antipsychotic QM rating is suppressed for six months and the long stay antipsychotic QM is suppressed for 12 months. The lifting of the downgrade and/or suppression at the timeframes above are subject to CMS verifying the issues have been corrected.

Facilities may opt to forego the CMS audit by self-reporting miscoding errors and agreeing to correct the issue. This reduces the burden of conducting audits and allows CMS to audit more facilities.  To incentivize this admission and to promote improvement, for facilities that admit miscoding after being notified by CMS that the facility will be audited, but prior to the start of the audit, CMS will consider a lesser action related to their star ratings. This may include the suppression of the QM ratings (rather than downgrade).

Christine Twombly, RN-BC, RAC-MT, RAC-MTA, HCRM, CHC
Clinical Consultant

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