News for MDS Experts

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

🚨𝗧𝗼: 𝗣𝗕𝗝 𝗣𝗿𝗼𝘃𝗶𝗱𝗲𝗿𝘀, 𝗩𝗲𝗻𝗱𝗼𝗿𝘀
The Centers for Medicare & Medicaid Services (CMS) is excited to share that the Payroll-Based Journal (PBJ) system will move into iQIES on 𝗔𝘂𝗴𝘂𝘀𝘁 𝟭𝟳, 𝟮𝟬𝟮𝟲. iQIES is a secure, cloud‑based system that CMS uses to collect and manage quality and compliance information. Moving PBJ into iQIES is part of ongoing work to modernize systems and improve security. Starting August 17, 2026, you must submit all PBJ staffing data in iQIES. Your reporting requirements and quarterly deadlines will not change.
𝘊𝘔𝘚 𝘸𝘪𝘭𝘭 𝘱𝘳𝘰𝘷𝘪𝘥𝘦 𝘢𝘥𝘥𝘪𝘵𝘪𝘰𝘯𝘢𝘭 𝘪𝘯𝘧𝘰𝘳𝘮𝘢𝘵𝘪𝘰𝘯 𝘣𝘦𝘧𝘰𝘳𝘦 𝘵𝘩𝘦 𝘭𝘢𝘶𝘯𝘤𝘩 𝘵𝘩𝘳𝘰𝘶𝘨𝘩 𝘷𝘢𝘳𝘪𝘰𝘶𝘴 𝘦𝘮𝘢𝘪𝘭 𝘯𝘰𝘵𝘪𝘧𝘪𝘤𝘢𝘵𝘪𝘰𝘯𝘴 𝘳𝘦𝘨𝘢𝘳𝘥𝘪𝘯𝘨 𝘰𝘯𝘣𝘰𝘢𝘳𝘥𝘪𝘯𝘨, 𝘵𝘳𝘢𝘪𝘯𝘪𝘯𝘨, 𝘥𝘦𝘵𝘢𝘪𝘭𝘴 𝘰𝘯 𝘸𝘩𝘢𝘵 𝘵𝘰 𝘦𝘹𝘱𝘦𝘤𝘵, 𝘢𝘯𝘥 𝘮𝘰𝘳𝘦. Correction: qtso.cms.gov/news-and-updates/correction-iqies-pbj-launch-announcement
***Please see the corrected task numbering below.
Create a HCQIS Access Roles and Profile System (HARP) account - Skip this step if you already have a HARP If you do not have an account, register here.
Request access to iQIES- Submit your request early so your access is ready before launch. Although you may request your PBJ role before August 17 (and CMS strongly recommends you do so), PBJ functionality will not be available for use in iQIES until August 17, 2026.
Choose the correct PBJ role within iQIES - Role descriptions are listed below.
PSO: Can view, upload, edit PBJ data and run PBJ reports. This role also approves user access.
PBJ Submitter (Provider or Vendor): Can view, upload, edit PBJ data and run PBJ reports.
Provider Administrator: View-only access and run PBJ reports.
PBJ Viewer: View-only access and run PBJ reports.
Additional information on roles can be found in the iQIES Onboarding Process - Provider User Roles Manual posted on the iQIES Reference and Manuals on QTSO under iQIES Onboarding Guides.
Get approval from your facility's Provider Security Official (PSO)- Your access will not become active until they approve it. Each facility must have at least one PSO to manage access for additional users.
Once you register for an iQIES account, be sure to log in regularly. If you do not log in for 60 days, you’ll lose access to iQIES. Additional information on the iQIES Inactive User Policy can be found on QTSO.
Vendors must request access for each facility they represent and get approval from a PSO at each facility, using the facility’s CMS Certification Number (CCN). ... See MoreSee Less