The 2025 Final Rule introduced a major new requirement for skilled nursing facilities: beginning in FY 2027, CMS will audit MDS-based quality measures for the QRP program. Each year, up to 1,500 SNFs – about 10% nationwide – will be randomly selected, with no facility chosen more than once per fiscal year. CMS has contracted with Healthcare Management Solutions, LLC (HMS) to manage the audit process.
Selected facilities will receive notification through their iQIES MDS 3.0 Provider Preview Report folder and must submit up to 10 complete medical records within 45 days. Failure to provide 100% of the requested records on time will result in a 2% reduction in Medicare Part A reimbursement for that fiscal year.
For now, the only audit requirement is timely, complete submission. However, CMS has indicated that accuracy thresholds may be added in future rulemaking.
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