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March 03, 2023

CMS to Begin Auditing Nursing Homes Due to Concerns of Erroneous Diagnoses and Improper Antipsychotic Drug Use

On January 18, 2023, CMS announced its plans to begin offsite audits of schizophrenia coding to ensure that nursing homes are not making false schizophrenia diagnoses and, in turn, misrepresenting their rates of antipsychotic drug use. CMS gives nursing homes an overall quality rating that is posted on CMS’s Nursing Home Care Compare website, and the percentage of long-stay residents who receive antipsychotic drugs is one of the quality measures used in CMS’s star rating calculation. CMS will review facility records, with attention to whether the records include behavior documentation and psychiatric evaluations to support a diagnosis of schizophrenia, to confirm whether coding of schizophrenia is accurate.  If an audit reveals improper coding by a facility, CMS will adjust the facility’s star rating.  

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