In 2016, the Centers for Medicare & Medicaid Services started focused on-site surveys to address the issue of erroneous coding of schizophrenia in nursing homes.
More recently, the agency began conducting off-site audits to assess the accuracy of Minimum Data Set (MDS) data. They are currently examining nursing homes’ evidence for appropriate documentation, assessment, and coding of residents’ schizophrenia diagnoses.
If CMS identifies inaccuracies in a nursing home’s MDS coding, the facility’s Five-Star rating will be downgraded by one star for six months, which can negatively impact admissions, jeopardize community partnerships, and draw attention from other external stakeholders. However, even more concerning is how these coding problems affect residents.
