Prepare Your SNF for a Brand-New Survey Process

SNF Survey Process

Like most skilled nursing facilities (SNFs), you and your staff are likely neck-deep in preparations for the new survey requirements of participation (RoPs). SNFs are in the midst of Phase 2 implementation, which includes a new survey process, as well as updated Interpretive Guidance (IG), revised F-Tag numbering and brand new F-Tags.

Although you have a reprieve on fines and penalties, your SNF can still face citations if your compliance is lackluster, explains Marilyn Mines, RN, BC, RAC-CT in her webinar for ProfEdOnDemand on  the new SNF survey RoPs for 2018. You will need to prepare your staff and residents for the new surveys— and educate your entire interdisciplinary team regarding the revised process.

CMS Will Combine 2 Surveys Into 1

The new survey process will combine traditional surveys and the Quality Indicator Survey (QIS). The Centers for Medicare & Medicaid Services (CMS) decided to combine these two different surveys to improve efficiency and effectiveness, as well as to establish a single nationwide survey process, according to a CMS training on the new long-term care survey process.

If your SNF has been surveyed under the traditional process, your staff will need to get up to speed on how the QIS process works, stated Leah Killian-Smith, Director of QA & Government Services for Pathway Health in a recent company posting. For those who already have QIS in their states, the transition may be a little easier because you’ve experienced both types of surveys. But many staff members have not experienced both—so education on survey readiness will be crucial.

What to expect: Under the new method, each survey team member will use a tablet or laptop throughout the survey process to record findings in the new software, CMS explains. The sample size that the surveyor will examine is determined by the facility census, with a maximum of 35 residents. The sample will consist of 70 percent MDS pre-selected residents and 30 percent surveyor-selected residents. Surveyors will finalize the sample based on observations, interviews, and a limited record review.

Don’t Greet Surveyors Empty-Handed

Be ready: Immediately after walking through your door, surveyors will expect you to have certain items on-hand. Under the new process, surveyors will ask you for a completed matrix for new admissions over the last 30 days, your facility census number, an alphabetical list of residents, a list of residents who smoke, and the designated smoking times.

This is a lot more information than you’re used to handing over upon a surveyor’s arrival: Traditional surveys required only the Roster Sample Matrix Form (CMS-802), and QIS required a census number, resident list, and list of new admissions.

Also, you will no longer need to provide the surveyor with a formal tour. Instead, surveyors will start observing every resident in their assigned area to identify about eight residents for the initial pool process. Surveyors will then spend about eight hours completing observations, interviews, and records review for the residents selected for the initial pool process, CMS explains.

Hot topics: Part of the surveyor’s review will cover quality-of-life and quality-of-care areas. During interviews, surveyors can ask questions as they would like, as long as they stay within the intent of the area. And the survey team will select the residents for the sample under the new survey process.

Finally, the new survey process includes a group interview with residents who are active members of the resident council, CMS states. The questions that surveyors ask during the group interview are different from those asked in both QIS and traditional surveys.

Understand the Survey Method

The biggest changes you’ll notice that the new survey is entirely computer-based and contains the following major parts:

  1. The initial pool process;
  2. Sample selection; and
  3. The investigative process.


Best strategy: To survive the new surveys, your SNF staff—especially your interdisciplinary team, administrators, and compliance officers—must become comfortable with the new tools and processes involved, according to Mines. But take heart: SNFs in every state will be facing this new process, so you’re not alone!

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