In the FY 2025 SNF Prospective Payment System (PPS) Final Rule, the Centers for Medicare and Medicaid Services (CMS) finalized a policy for Skilled Nursing Facilities (SNFs) who participate in the SNF Quality Reporting Program a validation (i.e., audit) process beginning in the fall of 2025 for the FY 2027 SNF QRP. This process is a similar one adopted for the SNF Value-Based Purchasing Program.
Key components of the validation program include:
- CMS’ contractor Healthcare Management Solutions, LLC (HMS) will randomly select up to 1,500 SNF each FY to submit MDS records for review.
- Selected SNFs will be notified through their iQIES MDS 3.0 Provider Preview Report folder.
- Selected SNFs are required to submit requested medical chart documentation to support validation of 10 MDS assessment records.
- Any selected SNF that fails to submit requested medical chart documentation within 45 calendar days of the audit notification will be considered noncompliant, resulting in the SNF losing 2% of Medicare reimbursement for the applicable fiscal year.
CMS has a webpage where additional information is available, including resource materials. This includes a Frequently Asked Questions document providing comprehensive information about the program.
If after reviewing the available resources, you are still seeking additional information, you may contact the SNF Validation Help Desk at snfvalidation@hcmsllc.com.