Your Facility Received a CMS Non-Compliance Letter. Now What?
When a CMS non-compliance letter arrives, the immediate priority is usually correcting the issue. But the bigger opportunity is understanding what allowed it to happen in the first place.
CMS issued FY 2027 Annual Payment Update non-compliance letters on August 5. The update identifies influenza vaccination reporting, healthcare personnel COVID-19 vaccination reporting and an MDS submission rate below 90% among the areas associated with the letters. Providers should check their iQIES Non-Compliance folder. Once the letter is in hand, resist the temptation to treat it as a one-time correction.
Find the Process Failure
Start with the specific requirement identified by CMS. Then work backward. If the issue involves MDS submissions, for example, don't stop with identifying who was responsible for the submission. Determine where the process broke down.
Was information missing? Were required MDS interviews missed? Was something submitted late? Was there a tracking issue? Did a change in staffing create a gap?
The answer matters because correcting the immediate problem does not necessarily correct the process.
Ask What You Should Have Known
One question I encourage administrators to ask is: Did we know about this issue before CMS sent the letter?
If the answer is no, take a closer look at how the facility monitors these areas. The goal isn't to assign blame. It's to determine whether the right information is reaching the right people early enough to address a problem before it becomes a compliance issue.
Compliance should not depend on discovering an issue after the reporting period has closed. Leadership needs enough visibility to know whether key requirements are being met while there is still time to intervene.
That does not mean administrators need to manage every reporting detail. It means they need a reliable way to know when something requires attention.
Turn the Letter Into a Process Review
Once the immediate issue has been addressed, look at the surrounding requirements. A gap in one reporting process may point to a weakness elsewhere. Review who owns the requirement, who verifies the information and how leadership knows the requirement has been met. Then document the change.
Becoming familiar with the CMS iQIES reports pertaining to the Annual Payment Update (APU) is a great starting way to ensure that you have a process in place to ensure system failures are not occurring. The report is titled, “SNF QRP Provider Threshold Report” and will identify an organization's current performance.
A non-compliance letter is a problem, but it can also reveal where a process needs to be stronger. The real opportunity is to know there is a problem before CMS does.
