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SNF Quality Reporting Program Notices of Noncompliance and Reconsideration Requests

7.19.2018

The Centers for Medicare and Medicaid Services (“CMS”) has issued notification letters to skilled nursing facilities (“SNFs”) that are not in compliance with the SNF Quality Reporting Program requirements. According to CMS, all noncompliance notices were mailed by Medicare Administrative Contractors (“MACs”) and placed into the Quality Improvement and Evaluation Systems – Certification and Survey Provider Enhanced Reporting (“CASPER”) system folders on July 9, 2018. These notices are important because a determination of noncompliance could subject a SNF to a two (2) percentage point reduction in their upcoming Fiscal Year 2019 Annual Payment Update (APU).

What can you do if you received a notice? First, a provider needs to review the letter carefully. Federal regulations allow a provider thirty (30) days from the date of the notice to request a reconsideration review. Reconsideration requests must be submitted no later than August 7, 2018 for the noncompliance notices issued on July 9. The only method for the submission of a reconsideration request is through email. CMS conducts its review based solely on the reconsideration request and accompanying documentation. Therefore, it is essential, and required, that providers submit documentation demonstrating compliance with the Quality Reporting Program requirements with their reconsideration request. The CMS SNF Quality Reporting Reconsideration and Exception and Extension webpage, provides helpful examples of documentation that would support compliance. A SNF should review the list to ensure that it provides the necessary documentation to support its reconsideration request. CMS will not review reconsideration requests submitted without the necessary supporting documentation.

When preparing a request for reconsideration, review the instructions in your notification letter and on the CMS SNF Quality Reporting Reconsideration webpage for the information required to be submitted. Review the request carefully to make sure that information is accurate (for example, make sure that the SNF CMS Certification Number (CCN) is correct). Also, the email reconsideration request is not a secure transmission so do not submit any protected health information, patient identifiable information or patient lists with your reconsideration request. Any transmission of protected health information with the emailed reconsideration request could lead to violations of the Health Insurance Portability and Accountability Act (HIPAA) by a SNF.

CMS should acknowledge receipt of the reconsideration request within five (5) business days through an email. Following its review of the request and supporting documentation, CMS will issue its decision by regular mail and an electronic letter through the CASPER system. If the decision upholds the finding of noncompliance, a provider may file an appeal with the Provider Reimbursement Review Board.

If your SNF has received a notice of noncompliance, review the notice and instructions immediately and be ready to act.

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Iain Stauffer is a member of the Health Care team at Poyner Spruill. He can be reached at 919.783.2982 or by email at istauffer@poynerspruill.com.

Physical Address: 301 Fayetteville Street, Suite 1900, Raleigh, NC 27601 | © Poyner Spruill LLP. All rights reserved.

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