News for MDS Experts

Happy Fourth of July!

Today, we celebrate the freedoms we enjoy and honor those who have served and continue to serve our country.
From all of us at MDS Consultants, we wish you, your families, and your residents a safe, happy, and relaxing Independence Day.

Thank you to the healthcare professionals working through the holiday to provide exceptional care. Your dedication does not go unnoticed.

Have a wonderful Fourth of July!
❤️🤍💙

#fourthofjuly #IndependenceDay #longtermcare #SkilledNursing #HealthcareHeroes #MDSCONSULTANTS #ThankYouHealthcareProfessionals ... See MoreSee Less

The CMS iQIES Survey and Certification User Manuals have been updated. qtso.cms.gov/software/iqies/reference-manuals ... See MoreSee Less

The Instructions for the Interim LTCSP Initial Survey and Certification Process have been edited effective 6/23/2026 related to the iQIES updates.
www.cms.gov/medicare/provider-enrollment-and-certification/guidanceforlawsandregulations/nursing-...
www.cms.gov/files/zip/initial-surveys.zip
www.cms.gov/files/document/revision-history-ltc-survey-process-documents-files-06-23-2026.pdf ... See MoreSee Less

OIG's objective was to determine whether nursing homes’ RN staffing hours reported in CMS’s PBJ were supported in accordance with Federal requirements. Nursing homes participating in the Medicare or Medicaid programs are required to electronically submit complete and accurate direct care staffing information to the Centers for Medicare & Medicaid Services’ (CMS’s) Payroll-Based Journal (PBJ) system. Direct care staff include nurse staff (e.g., registered nurses [RNs] and nurse aides) and non-nurse staff (e.g., therapists and social workers). The information that nursing homes report for each direct care staff member includes, among other things, the category of work (e.g., director of nursing, RN with administrative duties, or RN) and the number of hours paid to deliver services for each day worked.
𝗪𝗵𝗮𝘁 𝗢𝗜𝗚 𝗙𝗼𝘂𝗻𝗱
Not all nursing homes’ RN staffing hours reported in CMS’s PBJ were supported in accordance with Federal requirements.
For 45 of 100 sampled items, nursing homes reported a net of 748.5 hours that were not supported.
For 2 of 100 sampled items, nursing homes reported 336 hours that could not be verified because the nursing homes did not provide supporting documentation.
𝗪𝗵𝗮𝘁 𝗢𝗜𝗚 𝗥𝗲𝗰𝗼𝗺𝗺𝗲𝗻𝗱𝘀
We made four recommendations to CMS, including that CMS educate nursing homes on updated guidance for submitting staffing information and communicate to nursing homes on trends in CMS PBJ audit findings. The full recommendations are in the report. CMS concurred with two recommendations and did not concur with one recommendation. CMS did not indicate concurrence or nonconcurrence with the remaining recommendation.
oig.hhs.gov/reports/all/2026/cmss-processes-were-not-effective-in-ensuring-the-accuracy-of-staffi... ... See MoreSee Less

📢 Industry Update

According to reporting by McKnight's Long-Term Care News, a recent HHS OIG audit identified a 5% error rate in Payroll-Based Journal (PBJ) registered nurse staffing data and recommended that CMS strengthen audit oversight, improve follow-up on reporting errors, and share common findings with providers.

The audit identified both overreported and underreported RN hours, along with documentation issues involving meal breaks, unpaid hours, and reporting inaccuracies.

As PBJ data continues to impact Care Compare, Five-Star ratings, and regulatory oversight, this serves as a reminder that accurate staffing documentation, payroll records, and PBJ reporting continue to play an important role in compliance and quality monitoring.

Source: cstu.io/fecb6c

What are your thoughts? Do you think additional education and feedback will improve PBJ reporting accuracy, or are stronger audit requirements needed?

#LongTermCare #PBJ #FiveStar #CareCompare #HealthcareCompliance #MDS #SkilledNursing #QualityImprovement ... See MoreSee Less

Quality Measures don't just impact care—they impact reimbursement.

Join Jessica Stucin and Kristine Martinez as they break down how SNF Value-Based Purchasing (SNF VBP) is changing the way facilities monitor quality measures, prepare for survey, and protect reimbursement.

In this session you'll learn:
✔️ How SNF VBP quality measures affect your facility
✔️ Which MDS 3.0 QMs connect to Care Compare and Five-Star
✔️ Strategies to prepare for upcoming SNF QRP changes

📅 July 7
🎓 QM Series – Part 4

Reserve your spot today!
👉 www.mdsexpert.com/webinars-training/?utm_source=linkedin,%20facebook&utm_medium=social%20media&ut...

#MDSExperts #SNFVBP #QualityMeasures #MDS #LongTermCare #SkilledNursing #CareCompare #FiveStar #SNFQRP #HealthcareEducation ... See MoreSee Less

📢MLN Fact Sheet: Skilled Nursing Facility 3-Day Rule Billing Update
𝙒𝙝𝙖𝙩’𝙨 𝘾𝙝𝙖𝙣𝙜𝙚𝙙? They included information on the Transforming Episode Accountability Model (TEAM) Skilled Nursing Facility (SNF) 3-Day Rule Waiver (page 3).
3-Day Rule Waiver Certain Medicare Shared Savings Program Accountable Care Organization (ACO) participation options (called tracks) and CMS Innovation Center models offer the opportunity to use—or apply for, in the case of the Shared Savings Program—a SNF 3-Day Rule Waiver. Models include: ● ACO Realizing Equity, Access, and Community Health (REACH) ● Transforming Episode Accountability Model (TEAM) Participants in models, as well as track participants with an approved SNF 3-Day Rule Waiver, can offer SNF services without a prior 3-day inpatient hospitalization. This waiver may apply when the patient meets eligibility criteria and is admitted to an approved SNF.
www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/mln-publications-ite... ... See MoreSee Less

𝗠𝗲𝗱𝗶𝗰𝗮𝗿𝗲 𝗕𝗲𝗻𝗲𝗳𝗶𝗰𝗶𝗮𝗿𝘆 𝗗𝗮𝘁𝗲 𝗼𝗳 𝗗𝗲𝗮𝘁𝗵 - Manual Update I. SUMMARY OF CHANGES: The purpose of this Change Request (CR) is to add manual instructions for a Medicare beneficiary's date of death and reporting instructions for a beneficiary's date of death. EFFECTIVE DATE: July 13, 2026 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: July 13, 2026.
www.cms.gov/medicare/regulations-guidance/transmittals/2026-transmittals/r13826cp/?utm_source=con... ... See MoreSee Less