How to get your SNF survey-ready

In addition to enhanced oversight around infection control at skilled nursing facilities, CMS has authorized states to step up routine surveys. How prepared is your facility for a routine inspection or a special focused survey?

Key regulations to understand

Survey readiness begins with understanding clinical quality programs and reporting requirements that directly impact survey results, such as:

  • Quality Assurance and Performance Improvement (QAPI) program
  • The Special Focus Facility (SFF) program
  • SNF Quality Reporting Program (QRP)
  • Federal tags and how they’re calculated

Survey results directly impact your business

SNFs should take steps to adequately prepare for surveys. A low survey score can result in:

  • Lower Medicare and Medicaid reimbursements
  • Financial penalties
  • Decreased star ratings
  • Fewer referrals
  • Reduced revenue

Data is critical to survey success

Without a doubt, survey preparedness and accurate quality data are paramount to SNF survival in today’s healthcare environment. The processes you develop, and your documentation are essential to shining on a survey.

Without a data-driven approach, survey success is an uphill battle. Fortunately, ABILITY CAREWATCH enables you to use your facility’s quality data to help surveys go smoothly.

Take the guesswork out of surveys with ABILITY’s easy-to-use application. Discover how in our on-demand webinar.


ABILITY and design®, ABILITY® and CAREWATCH® are trademarks of ABILITY Network, Inc.

Celebrate Heart Awareness on World Heart Day with ABILITY CAREWATCH®

As World Heart Day approaches, ABILITY Network would like to encourage everyone to be heart aware.

The heart is the strongest muscle in the body, but worldwide, more people die from cardiovascular disease every year than from any other cause.1 This makes attention to heart health imperative.

For long-term care providers, one way to prioritize resident heart health is by utilizing features within ABILITY CAREWATCH®, such as Diagnosis Watch. This feature tracks heart-related diagnosis codes for all residents – but identifying residents with heart conditions is just the first step. The real benefit is using this information as a guide in establishing staff training programs around looking for heart-related condition signs and symptoms and how to care plan properly. Not only can this education improve the lives of your residents, but it can also assist you with survey preparedness.

We believe proper training is essential, and to support you and your team, we have a staff of nurses ready to meet your educational needs as well as application support needs. Our team is continuously trained on the latest CMS rules and regulations and other areas of post-acute care.

One of our senior clinical educators is Sarah Becker, RN, RAC-CT, QCP.

Sarah recently hosted a customer webinar on determining the proper PDPM primary diagnosis. The presentation explored several of the PDPM rules, with scenarios to show how to choose the primary diagnosis on an MDS assessment using the ABILITY CAREWATCH ICD-10 Lookup tool.

For example, let’s evaluate the use of ICD-10 code I10 (hypertension) versus code I110 (hypertension with heart failure). Using I10 as a primary diagnosis code in an MDS assessment would yield no payment, whereas I110 would be acceptable for the PDPM Clinical Category, “Cardiovascular and Coagulations.”

ABILITY values the importance of maintaining education in all areas of life, including cardiovascular disease and overall heart health, and we encourage everyone to learn more at the World Heart Federation.


Featured Clinical Educator

Ten steps SNFs must take for stronger infection protection and control

Skilled nursing facilities (SNFs) face unique challenges when it comes to infection prevention and control. The close-contact nature of SNFs and an older adult population – many with underlying medical conditions – put residents at increased risk of severe illness from infectious diseases.

Due to the elevated risk of contracting infections, SNFs need to be on alert to prevent infections and ensure the facility is as safe an environment as possible. According to the CDC, “a strong infection prevention and control (IPC) program is critical to both residents and healthcare personnel.”

While federal regulations have been in place since 2016 that require facilities to have infection control and prevention programs, the COVID-19 pandemic has brought renewed attention to the oversight of these programs. For example, the Centers for Medicare & Medicaid Services  (CMS) recently instituted a rule that requires SNFs to report COVID-19 vaccination status for residents and staff.

If ever there was a time to step up your organization’s infection prevention and control to limit potential transmission routes and reduce overall risk, it’s now. Every SNF is required to have a program that investigates, controls and keeps infection from spreading.

Here are ten steps you can take to combat infectious disease, comply with regulations, and improve patient outcomes at your organization:

  1. Educate all staff on hygiene guidelines and infection protocols
  2. Monitor adherence to facility-wide infection prevention procedures
  3. Stay up to date on regulatory and reporting requirements
  4. Employ a professional infection preventionist
  5. Hold regular infection control committee meetings
  6. Designate someone to coordinate IPC program activities
  7. Incorporate infection control into your QAPI process
  8. Perform infection surveillance with ongoing analysis of the data
  9. Implement a system to streamline regulatory reporting
  10. Understand the pertinent federal tags and prepare for infection-focused surveys

Ready to take your IPC program to the next level? ABILITY can help.

Watch our on-demand webinar to learn how you can streamline and proactively manage your infection control process for better outcomes.

ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.

Is the Value-Based Purchasing program on its way out? What SNFs need to know.

The SNF Value-Based Purchasing (VBP) program is in for an overhaul. The Medicare Payment Advisory Commission (MedPAC) has been advocating to replace the current program with an alternative that is more equitable across skilled nursing providers and that builds in financial incentives to motivate quality improvement efforts more effectively.

On July 29, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes raising the number of quality measures in the program. Here’s what SNF organizations need to know about the upcoming modifications to the SNF VBP program.

Why is the SNF VBP program changing?

The SNF VBP program is supposed to reward SNFs with incentive payments that reflect the quality of care provided to Medicare beneficiaries. However, in a mandated assessment, MedPAC concluded that there were “fundamental design flaws” in the current SNF VBP program and recommended it be “replaced as soon as possible.”

According to the Commission, shortcomings of the program include:

  • Use of only a single outcome measure – hospital readmissions – to assess performance
  • A reward system that does not motivate all providers to improve quality
  • Failures to address social risk factor variations across patient populations
  • Not distributing all withheld funds

What changes are expected?

The FY 2022 SNF Prospective Payment System (PPS) Final Rule lays out the following the provisions that will impact the SNF VBP:

  • The Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) will be suppressed for FY 2022 due to COVID-19
  • All participating SNFs will be assigned a performance score of zero to address possible distortion of performance scores and incentive payment multipliers
  • The federal per diem rate for each SNF will be reduced by 2%, and 60% of the withhold will be awarded back, resulting in a 1.2% payback to those facilities that meet their targets
  • Up to nine additional measures may be applied to the SNF VBP program beginning in FY 2024

What’s next and how can SNFs prepare?

The expanded SNF VBP will undoubtedly incorporate multiple performance measures, focus on patient outcomes and resource use for scoring and account for social risk factors.

While any new changes are limited to functional status, patient safety, care coordination or patient experience, new measures will still need to go through the rulemaking process. Currently, CMS is considering measures that are already required for long-term care facilities (LTCFs) in addition to input provided by stakeholders.

The best way for SNFs to prepare is to ensure their quality programs include technology to track quality metrics and provide analytics to improve performance.

This can be achieved with ABILITY CAREWATCH, a proven application that helps organizations simplify quality management, monitor their incentive multiplier, stay current with regulatory changes and optimize incentive payments under SNF VBP.


ABILITY and design®, ABILITY® and CAREWATCH® are trademarks of ABILITY Network, Inc.

How to optimize your clinical data for SNF surveys and PDPM reimbursement

A lot has happened since last summer when CMS issued guidance for surveys and enhanced enforcement around infection control at skilled nursing facilities. The regulatory agency also authorized states to expand survey activities to include more routine surveys upon entering phase 3 of the nursing home reopening guidance or earlier at state discretion.

With the renewed attention on the issues of quality and oversight, most states have now resumed their standard nursing home inspections alongside focused infection control surveys.

From keeping up with regulatory changes and avoiding deficiencies to managing PDPM and Five-Star Ratings, you have a lot on your plate. Without a doubt, survey preparedness and accurate quality data are paramount to compliance and proper reimbursement.

Fortunately, you don’t have to go it alone – ABILITY is with you every step of the way! We continuously make software improvements to help post-acute facilities better manage quality and keep up with the latest regulations.

We have integrated some exciting new features into ABILITY CAREWATCH that help SNFs optimize their clinical data for surveys and PDPM reimbursement in a post-COVID world. These enhancements include:

  • A built-in PDPM Calculator enables you to ensure proper reimbursement and maximize revenue potential. You can use it to identify the reimbursement and care level of each patient, decide whether to submit an Interim Payment Assessment (IPA), and make strong clinical and financial decisions related to your patient population and potential admissions.
  • The Survey Watch page now uses data sourced from Nursing Home Compare (NHC), giving you the most up-to-date survey data to prepare for surveys. NHC data is updated monthly, whereas the previously used OSCAR data is only updated on a quarterly basis.
  • The CMS SNF Survey Report has a new user interface that offers data export functionality and allows you to expand and collapse details for different types of surveys to facilitate data comparison and analysis.
  • The Focused Survey Report has been updated with the new user interface that features data export functionality. It also allows you to use colored checkmarks to differentiate manual report changes.

With ABILITY CAREWATCH, you always have the right quality management application at the right time!

Discover more about how you can position your facility for PDPM and survey success right here.


ABILITY and design®, ABILITY® and CAREWATCH® are trademarks of ABILITY Network, Inc.


Long-term care facilities now required to report COVID-19 vaccinations under new CMS rule

Long-term care facilities must now have programs in place to deliver COVID-19 vaccinations to all residents and staff who wish to receive them and provide information on the benefits of the vaccine, according to an interim final rule announced earlier this month by the Centers for Medicare & Medicaid Services (CMS)1.

The interim rule also mandates that facilities report staff and resident vaccinations weekly to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN). The information garnered through the reporting will help to identify facilities that require additional support in providing education and vaccines.

COVID-19 vaccination reporting requirements

COVID-19 vaccination reporting requirements apply to long-term care facilities, as well as intermediate-care facilities for individuals with intellectual disabilities. The new requirements are in addition to existing requirements to report COVID-19 testing, case and mortality data to the NHSN. They mirror existing reporting requirements for influenza and pneumococcal vaccines for long-term care facilities and carry similar penalties for noncompliance2 – $1,000 for the first failure to report and $500 per week for each subsequent failure.

Reporting requirements apply to all residents, as well as staff who work regularly within the facility.

Benefits of reporting vaccination data

According to CMS1, tracking of COVID-19 data will allow NHSN to identify facilities that need additional support in providing vaccinations and vaccine education to residents and staff. That support is especially important, CMS officials said, because of how hard hit residents and staff of Long-Term Care Facilities have been by COVID-19 infections and deaths. CMS officials also acknowledged that staff turnover at long-term care facilities can make effective vaccine programs a challenge, with programs requiring additional vaccine efforts as new staff members come on board.

Leveraging technology for easier vaccine reporting

Though the new reporting requirement places added burden on often short-staffed teams, technology can help facilities comply with the new rule and avoid penalties. ABILITY INFECTIONWATCH provides for easy reporting of COVID-19 vaccination data. The application enables COVID-19 vaccination reporting with:

  • Single-button access to accurate vaccination data for residents and staff
  • Exportable Excel/CVS files for quick copying and pasting of line listings and antibiotic usage reports available into NHSN templates
  • Tracking of what has and has not been reported to NHSN
  • A centralized hub for all vaccination data

Learn more about how your long-term care facility can meet COVID-19 vaccination reporting requirements with ABILITY INFECTIONWATCH.


1. CMS Expanding Efforts to Grow COVID-19 Vaccine Confidence and Uptake Amongst Nation’s Most Vulnerable,” Centers for Medicare & Medicaid Services, May 11, 2021,
2. Flynn, Maggie, “CMS Requires Nursing Homes to Report Staff and Resident COVID-19 Vaccination Status,” Skilled Nursing News, May 11, 2021,


ABILITY and design®, ABILITY® and ABILITY INFECTIONWATCH® are trademarks of ABILITY Network, Inc.

How new legislation and policies impact SNF infection prevention and control

The American Rescue Plan of 2021, which includes resources for skilled nursing facilities (SNFs), was signed into law in March. And in April, the Centers for Medicare & Medicaid Services (CMS) issued its Fiscal Year (FY) 2022 Skilled Nursing Facility Prospective Payment System Proposed Rule (CMS 1746-P), which includes two new Quality Reporting Program (QRP) measures.

After a tumultuous year, skilled nursing facilities are undoubtedly concerned about legislation and policies that affect their Infection Prevention and Control programs.

Here’s what you need to know about these recent changes.

How the new stimulus bill supports SNFs

The American Rescue Plan of 2021 was signed into law to support the country’s recovery from the economic and health effects of the COVID-19 pandemic. The $1.9 trillion relief package includes the following provisions to enhance infection control support at SNFs:

  • $200 million for quality improvement organizations to provide infection control and vaccination uptake support
  • $250 million to states to deploy “strike teams” (i.e., groups of public health, infection control and emergency response personnel) to assist with clinical care, infection control or staffing for up to one year after the COVID-19 emergency period ends
  • $8.5 billion added to the Provider Relief Fund for rural health care providers, including nursing homes, enrolled in Medicare or Medicaid that provide COVID-19 diagnosis, testing or medical care

Understanding the two new QRP measures

On April 8, 2021, CMS issued a proposed rule that included updates to the Skilled Nursing Facility Quality Reporting Program (SNF QRP). The rule includes two new quality measure proposals slated to begin FY 2023:

  1. Skilled Nursing Facility Healthcare-Associated Infections Requiring Hospitalization

The goal of this outcome measure is to identify SNFs with notably higher rates of healthcare-associated infections (HAIs) resulting in hospitalization, in comparison to peers. This proposed measure uses claims data to estimate the risk-adjusted rate of HAIs acquired during SNF care which result in hospitalizations.

The measure targets all infections that are serious enough to require admission to an acute care hospital. It is risk-adjusted to “level the playing field” and to allow comparison of performance based on residents with similar characteristics between SNFs.

  1. SARS-CoV-2 Vaccination Coverage Among Healthcare Personnel

This process measure tracks COVID-19 vaccination coverage among healthcare personnel (HCP) in many provider facilities, including SNFs. The measure will be used to assess whether SNFs are taking steps to limit the spread of COVID-19 among their staff, residents and local communities.

The measure quantifies the cumulative number of HCP eligible to work in the facility for at least one day during the reporting period and who received a complete vaccination course against SARS-CoV-2 since the date vaccine was first available. HCP with contraindications to SARS-CoV-2 vaccination are excluded.

SNFs will report vaccination data through the Centers for Disease Control and Prevention National Healthcare Safety Network beginning FY 2023. Facility-level COVID-19 HCP vaccination rates will be published on Care Compare.

Streamline infection prevention and control

ABILTY can help you make the most of relief funding and stay on top of regulatory changes. With ABILITY INFECTIONWATCH, your SNF team can closely monitor infectious disease outbreaks, track infection prevention and control strategies and simplify regulatory compliance. Discover how ABILITY INFECTIONWATCH can streamline infection surveillance and management at your facility today!


ABILITY and design®, ABILITY® and ABILITY INFECTIONWATCH® are trademarks of ABILITY Network, Inc.

Secure COVID-19 relief funds for your skilled nursing facility

Has your skilled nursing facility been diligent in tracking infection control and prevention during the COVID-19 pandemic? If so, your facility could be eligible for a portion of the $2 billion in relief funds being distributed by the U.S. Department of Health and Human Services (HHS). Additional details on how SNFs can receive incentive payments were recently released.

Eligibility for incentives

Previously, HHS announced that SNFs would be eligible for incentive payments based on how well they were able to control rates of COVID-19 infections, as well as COVID-19 mortality rates. HHS clarified the requirements last month, stating that facilities had to show that their rates of COVID-19 infections were lower than their counties’ rates of infection. The death rate among residents within the facility who tested positive for COVID-19 also had to be below a national performance threshold for mortality within nursing homes.

Those two measures serve as a “gateway” for participation in the incentive program. Each month, facilities must meet those two criteria to receive incentive payments. Eligible facilities will have their performances evaluated, with infection rates accounting for 80 percent of the incentive payment. Calculations will be made by dividing the facility’s number of non-admission COVID-19 infections by the total number of resident-weeks reported to the National Healthcare Safety Network (NHSN). The mortality rate will be calculated for any facility that reported at least one non-admission COVID-19 infection.

Tracking your facility’s incentive eligibility

How can you track your facility’s COVID-19 infections accurately to help qualify for relief funds? Many SNFs are turning to ABILITY INFECTIONWATCH to carefully track resident symptoms, infections and infection control measures. The application allows you to map infections within your facility and monitor data in real time to keep infection rates lower and maximize protection for residents and staff. ABILITY INFECTIONWATCH also helps administrators pull infection information and track the documentation required by NHSN.

Another application that can help SNFs qualify for COVID-19 incentives is ABILITY CAREWATCH. Facilities using ABILITY CAREWATCH to manage quality and QAPI incentives can more easily manage their Medicare and Medicaid licensing. Current licensing is required to receive incentive payments.

Staying up to date with infection reporting

COVID-19 incentive payments can help skilled nursing facilities like yours invest more in testing and PPE to keep residents and staff safe. Learn more about how ABILITY INFECTIONWATCH and ABILITY CAREWATCH can help your facility qualify for payments.



CMS audits have restarted: how skilled nursing facilities can prepare

The Centers for Medicare & Medicaid Services (CMS) resumed Recovery Audit Contractor (RAC) and Medicare Administrative Contractor (MAC) medical review audits in August.

Here’s what you need to know and how to prepare your skilled nursing facility in the event of an audit.

RACs and MACs are back

The ongoing COVID-19 public health emergency (PHE) brought considerable changes to healthcare facilities, including a temporary halt to most CMS audits on March 30, 2020. The suspension included prepayment and post-payment medical reviews conducted by MACs and RACs.

In July, CMS announced that it would be resuming medical review activities in August regardless of the status of the PHE. Audit activity ramped back up on August 17, prioritizing post-payment reviews of COVID claims submitted prior to March 1, 2020.

While CMS has not yet announced when the audits on claims submitted after March 1 will begin, they will likely commence in the coming months.

What you need to know

CMS has indicated that audits will be conducted in accordance with existing statutory and regulatory provisions, including related billing and coding requirements. However, any waivers or flexibilities that were allowed for any date of service under review will be applied in the audit.

Keep in mind that the rules changed rapidly at the onset of the PHE, which may increase the chances of audit errors as well as misapplication of rules and regulations.

If auditors are unable to make a determination on prepayment or post-payment claims review based on the information that’s been provided, they will issue an additional documentation request (ADR) to solicit supporting documentation.

While RAC and MAC audits historically have been done in person, CMS has expanded desk reviews during the pandemic. Although a remote audit may potentially be less burdensome on your organization, it will still be crucial to be organized and prepared.

Tips for audit response

CMS recognizes that many skilled nursing facilities have limited staffing and resources to respond to audits during this time. If your facility is selected for medical review, there are several actions you can take to facilitate the process.

  • Identify someone to manage the ADR and denial process
  • Promptly respond to every overpayment and audit letter (ADR)
  • Contact your auditor to discuss any COVID-19 related hardships you may be experiencing that could impact audit response timeliness
  • Avoid returning any overpayment before confirming and accepting the audit findings
  • Only send the specific information in the ADR to expedite the process
  • Make sure all documentation is legible and supports MDS coding and the UB-04

Boost audit success

Audits are disruptive even during the best of times. It’s more critical than ever to have an efficient and effective process in place to not only respond to an audit in a timely manner, but to also help you avoid one in the first place.

ABILITY CAREWATCH and ABILITY UBWATCH can help you get ahead of an audit request and potentially minimize the risk of an audit by ensuring accuracy between the MDS and UB-04. Data analytics and real-time reports give you access to:

  • Medicare roster
  • RUG 66 Watch page
  • Built-in Triple Check
  • Quality pages
  • And more!

There’s no time to waste! Get a first-hand view of how to use these applications to boost your audit response by requesting a demo today.



“Coronavirus waivers & flexibilities,” CMS, accessed October 9, 2020,

“MACs Resume Medical Review on a Post-Payment Basis,” MLN Connect eNews, CMS, August 6, 2020,

“CMS Announces Resumption of Routine Inspections of All Provider and Suppliers, Issues Updated Enforcement Guidance to States, and Posts Toolkit to Assist Nursing Homes,” CMS, August 17, 2020,


ABILITY and design®, ABILITY®, CAREWATCH® and UBWATCH® are trademarks of ABILITY Network, Inc.

Study shows disconnect between CMS infection control surveys and COVID outbreaks

A recent study of data from the Centers for Medicare & Medicaid Services (CMS) by the Center for Medicare Advocacy (CMA) has shown a disconnect between the results of CMS infection control surveys and outbreaks of COVID-19 within skilled nursing facilities.

Infection control citations

In mid-March, CMS announced that inspections would focus on infection control programs – in addition to cases of immediate resident danger – to help suppress the spread of COVID-19 within SNFs. A review of CMS inspection data by CMA showed that a very small portion of infection control surveys resulted in citations. Out of 5,724 infection control surveys performed from the March announcement through June 24, only 99 resulted in citations.1

Of the citations, 93 were marked as having minimal harm or potential for minimal harm, and three were marked as having a potential for minimal harm. The remaining three were marked as putting residents’ health and safety in immediate jeopardy. Thirty-five of the citations resulted in fines.

The disconnect between citations and infections

The concern raised by CMA has been raised by officials in many states, as well as by families of afflicted nursing home residents: With the high rate of COVID-19 cases in nursing homes, the low amount of citations – which translates to 2.4 percent of surveys – seems “implausible,” according to CMA officials. Through the end of June, more than 40 percent of COVID-19 deaths in the United States were related to skilled nursing facilities.2

The CMA’s review showed that several of the CMS infection control surveys that did not result in citations took place even as SNFs were in the middle of COVID-19 outbreaks. Three days after a passing survey at one California facility, there were 68 diagnosed COVID-19 cases documented. The staff refused to return to work over concerns for their safety, and members of the California National Guard were deployed to care for residents.3

Those eyeing the survey results give different causes for the disconnect between passing surveys and COVID-19 infections. Some say SNFs lacked access to the personal protective equipment needed to keep staff and residents safe. Others called out a lack of regular testing among residents and staff. One CMS administrator said the disparity between survey results and infection rates likely shows that SNF staff demonstrated compliance during surveys but failed to follow protocols when they were not under scrutiny.

Maintaining infection control programs

Amidst the COVID-19 pandemic, maintaining infection control protocol has become more important than ever in keeping residents and staff safe. The number of SNF deaths due to the pandemic and the results of the CMA’s data review could lead to further scrutiny of infection control programs or more stringent infection control program requirements.

SNFs can stay on top of regulations, infection control protocol and patient data with ABILITY INFECTIONWATCH. The application allows for easy tracking of McGeer criteria, infection reports and infection control measures. SNFs can tighten their vigilance against infections by customizing infection thresholds; when those thresholds are reached, an alert appears on the ABILITY INFECTIONWATCH dashboard so staff won’t miss the signs of an outbreak.



1. “Special Report Additional Infection Control Surveys at Nursing Facilities Show Same Results: Few Deficiencies, Most Called ‘No Harm’; Poor Ratings on Nursing Home Compare,” Miriam Edelman, July 9, 2020,

2 “More than 40 Percent of U.S. Coronavirus Deaths are to Nursing Homes,” The New York Times, July 23, 2020,

3 “As Coronavirus Raged Through Nursing Homes, Inspectors Found Nothing Wrong,” Jack Dolan & Brittny Mejia, June 28, 2020,


ABILITY and design® and ABILITY® and ABILITY INFECTIONWATCH® are trademarks of ABILITY Network, Inc.