A federal government shutdown creates uncertainty across many areas of healthcare oversight, and survey activity is no exception. To address this, the Centers for Medicare & Medicaid Services (CMS) has re-issued updated guidance clarifying how Survey & Certification activities must be handled during a partial, temporary federal government shutdown.

The revised guidance, QSO-26-01-ALL REVISED, was issued to State Survey Agencies and confirms that CMS’ long-standing contingency framework remains in place. While the memo is updated, the core expectations for survey operations during a shutdown have not changed.

The full QSO can be accessed here.

 

CMS’ Core Position During a Shutdown

CMS reaffirmed that during a federal shutdown, Survey & Certification work is legally limited to activities necessary to protect resident health and safety. In practical terms, this means that routine oversight and administrative survey functions are paused unless there is a direct connection to preventing harm or addressing serious safety risks.

This limitation is not discretionary, it is driven by federal law governing agency operations during a lapse in appropriations.

 

Survey Activities That Are Paused

Under the updated QSO, CMS confirmed that the following activities will not continue during a shutdown:

• Standard (annual) recertification surveys
• Initial Medicare certification surveys
• Complaint investigations that are triaged at non-harm levels
• Most revisit surveys
• Informal Dispute Resolutions (IDRs)
• Routine certification processing and related actions

For providers, this means that many expected survey-related timelines may temporarily stall, even though facilities remain responsible for ongoing compliance.

 

Survey Activities That May Still Occur

CMS also clarified that some survey activity may continue when it is directly tied to resident safety or Medicare participation. These include:

• Complaint investigations involving Immediate Jeopardy or actual harm
• Actions required to address serious life-safety concerns
• Revisits conducted only when necessary to prevent mandatory termination from Medicare participation

These activities are narrowly focused and are intended to ensure that critical risks to residents are addressed, even during a shutdown.

 

What the Re-Issued Guidance Means for Providers

Although CMS has updated and re-issued the QSO, the agency emphasized that the same shutdown framework remains in effect. The revised memo does not introduce new survey categories or expectations; instead, it reinforces existing policy and provides confirmation that prior guidance still applies.

Providers should not interpret a pause in routine survey activity as a relaxation of compliance obligations. Standards remain in effect, and survey activity may resume once the shutdown ends.

 

Ongoing Monitoring

HTS will continue to monitor CMS communications related to the federal shutdown and Survey & Certification activity. HTS Partners will be notified promptly if CMS issues additional clarification or changes to this guidance.

 

Power Points

During a federal government shutdown, survey activity becomes narrowly focused on resident health, safety, and Medicare participation. CMS’ updated QSO-26-01-ALL REVISED confirms that while many routine surveys pause, enforcement tied to serious risk continues.

Written By: Sheena Mattingly, EVP of Quality & Compliance

CMS has launched a new SNF Data Validation Process to verify the accuracy of quality measure data derived from the Minimum Data Set (MDS) used in both the Skilled Nursing Facility Quality Reporting Program (QRP) and the SNF Value-Based Purchasing (VBP) Program. This is not the typical admission-to-discharge audit many providers are used to. Instead, it targets specific MDS assessment timeframes tied to quality measures and clinical documentation.

 

How This Differs from Traditional Audits

• The data validation process does not review full admissions through discharge charts.
• CMS selects a small number of MDS assessments per facility (up to 10) to validate specific elements that drive quality measures (e.g., functional status, pressure injuries, falls, infections).
• The focus is on accuracy of MDS coding, and documentation must support the specific date ranges identified in the selection notification.

 

Selection and Notification

• CMS randomly selects eligible SNFs (those that submitted at least one MDS assessment in the relevant timeframe) on a rolling basis throughout the year. SNFs can only be selected once within a fiscal year.
• Notifications are posted in the iQIES MDS 3.0 Provider Preview Reports folder and will be clearly labeled (e.g., Initial Selection Notification, Second Selection Notification). Some providers have already received notification.
• Providers must actively monitor their iQIES folders; these notices are not broadly emailed.

 

Documentation Submission: Key Rules

Required Format

• All requested documentation must be submitted in PDF format.
• No other formats will be accepted.

 

Exact Naming Convention

CMS requires a strict naming convention for each PDF submission: CCN_ValidationID.pdf

 

Where:

• CCN = the six-digit CMS Certification Number assigned to the facility.
• Validation ID = the unique identifier CMS uses for that specific sampled assessment.

Example: A facility with CCN 111111 and a sample ID 1234 should submit: 111111_1234.pdf

This helps CMS track files precisely and reduces processing delays.

 

Timeframe for Records

• Only include documentation within the date range specified in the selection notice.
• Do not include unrelated records outside the targeted assessment window.

 

What Not to Include

To protect resident privacy and meet CMS guidelines:
❌ No Social Security Numbers
❌ No resident face sheets or unnecessary identifiers
❌ No documentation outside the requested date range

CMS explicitly states that submitted files should not contain resident SSNs or face sheets, and should be limited to what is necessary to support the MDS data elements under review.

 

Security and Submission Logistics

All files are stored in a secure CMS environment with encryption and access controls.

• Requested medical records are uploaded through a secure CMS portal.
• Providers receive automated email confirmations when files are uploaded successfully.
• A second email confirms when all documents have been verified as submitted.

 

Deadlines and Compliance

• Once selected, SNFs have 45 calendar days to submit all required documentation.
• Failure to respond within this timeframe can result in noncompliance, potentially triggering a 2% reduction in Medicare Annual Payment Update for the applicable QRP/VBP year. Noncompliance is measured by response, not the results of the audit.

 

Your Power Points

• This process is for data validation, not a full chart audit.
• Documentation must be PDF only with a strict naming convention.
• Only include records for the requested date ranges. Do not include extra files, SSNs, or face sheets.
• Check iQIES regularly for selection notices and deadlines.

 

For more information: Skilled Nursing Facility Validation Program: Frequently Asked Questions

Being prepared now with processes for naming, compiling, and submitting MDS-related documentation will help you stay compliant, protect reimbursement, and support accurate quality reporting.

 

Written By: Sheena Mattingly, EVP of Quality & Compliance

In skilled nursing facilities, CPT 97530 (Therapeutic Activities) is one of the most functionally rich, clinically powerful interventions therapists can provide. Yet despite its value, it is often misunderstood, misapplied, and underutilized.

Many clinicians refer to 97530 as the “–ing code” because it involves engaging patients in doing meaningful, functional activities. However, a common misconception persists: that any activity or education falls under 97530. In reality, education alone does not meet the criteria for 97530, and selecting it simply because teaching occurred is a coding error. 

What 97530 Actually Is

The CPT definition of 97530 is “therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes.”

This includes clinician-directed, functional task-oriented activities such as:

• Lifting
• Carrying
• Handling
• Reaching
• Transferring
• Transporting

It is not just performing an activity, it is the therapist’s analysis, grading, cueing, environmental setup, and clinical problem-solving during the functional task that make the service skilled.

 

What 97530 Is Not

97530 is Not:

• Verbal instruction without active performance
• Watching a demonstration
• A passive experience
• Simply “any activity the patient completes”

If you are educating, you bill the most appropriate code for the service being taught (e.g., 97535 for self-care training). Education paired with functional performance may fall under 97530, but education by itself does not.

 

Are We Underutilizing 97530?

There is a strong possibility that 97530 is used less than it should be. This is not because clinicians are doing less functional retraining, but because they default to other codes when they’re actually providing therapeutic activities.

For example, if the patient is actively practicing sit-to-stand transfers with graded cueing to improve functional mobility, that activity is almost certainly therapeutic activities, even if the therapist is also instructing them.

 

Accurate Use of 97530 is About Ensuring:

• The code matches the intervention
• Documentation reflects the skilled service performed
• The patient receives functional, meaningful therapy aligned with SNF goals

 

Coding Tips for Everyday Compliance:

• Understand CPT coding definitions
• Code only what is actually performed
• Report only skilled minutes
• Ensure documentation supports each code billed
• Follow payer and regulatory rules
• Remember: each minute billed must reflect skill, intent, and necessity

 

Clinicians are the heart of the compliance team. Coding is not just billing. It’s a clinical integrity practice. Accurate, intentional coding protects patients, clinicians, and the SNF.

 

Written By: Sheena Mattingly, EVP of Quality & Compliance