What You Should Know About New CMS Unannounced Nursing Home Verification Visits
(Sept. 9, 2024) LeadingAge National has heard from several nursing home members lately about unannounced visits being conducted by Centers for Medicare and Medicaid Services (CMS) contractors. These visits are related to provider enrollment and revalidation, though this may not always be immediately clear. LeadingAge National is working with CMS to improve these processes. In the meantime, they have compiled information to help members identify these visits and know how to respond.
A CMS contractor arrives at the nursing home without any prior notification to the facility and requests to take photographs. The contractor has a badge, but it is for the contracting company, not CMS. The contractor also has a letter from CMS explaining the purpose of the visit, but LeadingAge National is hearing that some contractors do not show this letter unless asked. Neither the contractor’s badge nor the CMS letter can be photographed. However, the letter contains a QR code that can be scanned for more information.
Some members have said that when they have reached out to the State Survey Agency or the CMS Regional Office to verify the contractor’s visit, neither the State Agency nor the CMS office is aware of the visit or able to provide additional information. Once permitted entry, LeadingAge National has been told that the visits are rather quick, with contractors verifying licensing information and taking photographs in which they take care not to include residents.
What do we know thus far from CMS?
- Site visits are contracted out by CMS to two site verification services contractors and their subcontractors:
- In the east, site visits are conducted by Palmetto GBA and its subcontractors:
- Overland Solutions, Inc., an affiliate of EXL
- Information Discovery Services
- Compliance Review, Inc.
- National Creditors Connection, Inc.
- In the west, site visits are conducted by Deloitte Consulting, LLP, and its subcontractors:
- Nationwide Management Services, Inc.
- CSI Companies, Inc.
- Arthur Lawrence Management, LLC
- Computer Evidence Specialists, LLC
- In the east, site visits are conducted by Palmetto GBA and its subcontractors:
- There are two possible types of site visits.
- One is an observational site visit.
- During an observational site visit, the contractor will take photos, but will have minimal contact with the provider.
- The second type of visit is a detailed review.
- During the detailed review, the contractor will speak with staff and collect information to confirm compliance with Medicare standards.
- One is an observational site visit.
What should a facility do to be prepared?
Nursing homes should make sure that staff, including any front desk or concierge staff, are aware of these visits and the nursing home’s internal protocols for how to handle them. When a contractor arrives, ask to see their badge and the CMS letter. To verify that these visits are legitimate, contact your Medicare Administrative Contractor. You can also find more information on these visits here.
Contact: Carrie Mosley, cmosley@leadingageny.org, 518-867-8383 ext. 147