Nursing Home News 2026July24
CMS to Roll Out Risk-Based Survey This September
The Centers for Medicare & Medicaid Services (CMS) released
memo QSO-26-14-NH on July 16 announcing that the Risk-Based Survey will be implemented in nursing homes nationwide beginning September 8, 2026. LeadingAge
called the announcement “a significant win”, noting that we have long advocated for this survey reform, both in our meetings with CMS and communications with the Department of Health & Human Services. CMS estimates that approximately 12% of nursing homes will be eligible for the Risk-Based Survey based on a combination of factors including Five-Star Quality Rating System ratings and other metrics. CMS additionally intends to identify these high performing nursing homes on Nursing Home Care Compare with a special icon and will identify any surveys completed using the Risk-Based Survey model on the survey results page, the form CMS-2567, and the CMS data catalogue. CMS will begin training surveyors in August and September and training materials, survey resources, and other supporting materials will be publicly available.
Learn more here. LeadingAge is pleased with this development and will continue to pursue reforms to improve the nursing home survey and certification process.
OIG Audit Finds $19.5 Million in Improper Medicare Part B Payments for Services Provided in Nursing Homes.
On July 20, the Department of Health and Human Services Office of Inspector General (OIG) released an audit finding that one Medicare Administrative Contractor (MAC), Novitas Solutions, improperly paid an estimated $19.5 million for certain Medicare Part B services furnished to beneficiaries residing in nursing homes. The audit reviewed claims for the period from October 1, 2018, through September 30, 2019, for evaluation and management, psychotherapy, and podiatry services and found that 91 of the 150 sampled claims did not meet Medicare requirements or documentation standards. Based on those findings, OIG estimated that millions of dollars in payments were made for services that should not have been reimbursed. The report focused on Novitas’ oversight of claims in one of its jurisdictions rather than on nursing homes themselves, but it underscores continued federal scrutiny of Medicare billing and documentation practices in post-acute and long-term care settings. The OIG recommended that Novitas strengthen its claims review processes to prevent future improper payments and provide annual education to providers and their billing staff specific to the Medicare requirements. Providers should expect ongoing attention from regulators and Medicare contractors on documentation supporting Part B services furnished to nursing home residents.










