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SNF Data Validation Program

In the FY 2025 SNF Prospective Payment System (PPS) Final Rule, the Centers for Medicare & Medicaid Services (CMS) finalized a new validation (audit) process for Skilled Nursing Facilities (SNFs) participating in the SNF Quality Reporting Program (QRP). Beginning in fall 2025, CMS will implement this process for the FY 2027 SNF QRP, modeled after the validation program used in the SNF Value-Based Purchasing Program.

Key features of the validation program include:
  • CMS' contractor, Healthcare Management Solutions, LLC (HMS), will randomly select up to 1,500 SNFs each fiscal year to submit MDS records for review.
  • Selected SNFs will be notified through their iQIES MDS 3.0 Provider Preview Report folder.
  • Chosen facilities must provide supporting medical chart documentation for 10 MDS assessment records.
  • SNFs that fail to submit the requested documentation within 45 calendar days of notification will be deemed noncompliant and assessed a 2% reduction in Medicare reimbursement for that fiscal year.
CMS has published additional program details, including resource materials and a comprehensive Frequently Asked Questions document, on its website. For further assistance, SNFs may contact the SNF Validation Help Desk at snfvalidation@hcmsllc.com.
 
Staff contact: mcarland@mehca.org
 

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