The Centers for Medicare & Medicaid Services (CMS) has identified that a significant number of improper payments are issued every year. In 2023 alone, the improper payment rate reported by CMS for Part D payments alone was nearly 4%, an increase from 2022.
The most common source of error is funds paid to the wrong entity. This can happen for multiple reasons, but the primary reason is insufficient documentation or payment amounts that are not supported by the documentation that was submitted.
CMS checks are performed to help avoid these issues, ensure adherence to state and federal regulations, and evaluate a facility’s performance and effectiveness.
What Are CMS Checks, and What Do They Entail?
CMS checks, often called CMS surveys, are thorough and detailed evaluations of a facility. The purpose is to ensure that healthcare facilities comply with federal regulations and standards. These surveys are critical in maintaining the quality and safety of healthcare operations and quality patient care.
The process is quite comprehensive. Some of these steps include:
- Documentation Reviews
- Staff Interviews
- An Entrance and Exit Conference
- Data Analysis
Every step in a CMS survey culminates in a detailed final report that presents in-depth findings. The post-inspection report helps facility managers and compliance officers become more aware of deficiencies that require immediate corrective actions.
The report will also include secondary deficiencies that require intervention. An initial CMS check helps facilities become more aligned with CMS standards in terms of the quality of patient care they deliver and their overall operations to help avoid penalties down the line.
Understanding the full scope of CMS checks helps healthcare providers better prepare for the review. Thorough preparation could also mean fewer adverse findings in the final post-survey report.
How CMS Guidelines Benefit Your Practice
CMS guidelines are designed to ensure the highest standards of patient care and safety. Overall, they can help healthcare providers become more aligned with value-based care practices by monitoring and tracking their facilities’ outcomes. This can help enhance population health and identify current disparities and interventions that a facility could apply over time.
Adhering to CMS guidelines offers a variety of other benefits for healthcare practices as well.
Improvement of Patient Outcomes
Compliance with CMS standards ensures that patients receive safe, high-quality care, leading to better health outcomes. The primary point of the CMS is to focus on areas of care that are patient-centered and based on the outcomes of care.
Better Risk Management
By following CMS guidelines, practices can minimize the risk of legal issues and financial penalties associated with noncompliance. Per the CMS, penalties will amount to $109,000 per hospital for a full calendar year of noncompliance.
However, remain aware that although there is a maximum for penalties, they still can reach more than $2,000,000 per hospital.
Enhanced Operational Efficiency
CMS guidelines promote best practices that can improve the efficiency and effectiveness of healthcare delivery. Facilities should remember that a strong compliance record also strengthens their reputation.
This will eventually lead to obtaining more patients, higher satisfaction ratings, and a larger group of skilled professionals. By integrating CMS guidelines into daily operations, healthcare practices can create safer, more efficient, and patient-centered environments.
Does a Healthcare Compliance Specialist Make a Difference?
A healthcare compliance specialist can be vital in navigating the monitoring and tracking of healthcare regulations. These professionals are well-versed in the nuances of CMS guidelines, and their purpose is to develop different procedures and processes that help facilities to easily comply with both federal and state regulations.
Their presence lightens the load of departmental responsibilities in terms of compliance, and they often can conduct internal audits, provide training to staff, and implement corrective actions to address any deficiencies that are found.
Tapping Into Continuous Improvement and Compliance Adherence With Technology
Aside from having access to compliance professionals, healthcare facilities can directly benefit from having compliance management software in place to complement their existing processes. Having access to an intuitive compliance dashboard, programs tailored to your operations, and on-demand compliance training can mean the difference between having to navigate significant financial penalties and not having to.
To get an idea of what your compliance dashboard could look like, work with Compliancy Group today.
