Schizophrenia Diagnosis & CMS Coding Audits

The Centers for Medicare & Medicaid Services (CMS) has made changes in recent months related to schizophrenia diagnosis. These changes are reflected in the updated Minimum Data Set (MDS) section I6000, the State Operations Manual (SOM) Appendix PP, and the Critical Element Pathways. The changes also can affect nursing homes' ratings in the Five-Star Quality Rating System. 

In today's episode, we discuss the latest guidelines on schizophrenia diagnosis and the background behind these changes, as well as schizophrenia coding audits CMS is conducting in long-term care facilities. We're joined by guest presenter Tammy Coleman, RN, CNDLTC, RAC-CT. Coleman is Vice President of Clinical Reimbursement at Affinity Health Services.

Related links:

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This material was prepared by Quality Insights, a Quality Innovation Network - Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-GEN-072723-CC-A