Q: CMS imposed a CMP for a deficiency that we do not agree with. Is there any recourse?
A: Perhaps. The Informal Dispute Resolution (IDR) process gives nursing homes one informal opportunity to dispute cited deficiencies after any survey of Federal requirements for participation.
Facilities also have the opportunity to request and participate in an Independent IDR if CMS imposes civil money penalties (CMPs) against the facility and these penalties are subject to being collected and placed in an escrow account pending a final administrative decision.
With either of these processes, you must understand the Federal Requirements outlined in 42 C.F.R. §488.331 and 488.431 to make sure that you adhere to the directives and understand when you can and cannot dispute cited deficiencies.
For example, for the IDR process, the request must be submitted in writing within the same 10-day window that would be used for a plan of correction, along with a specific explanation of what’s being disputed.
Facilities may not use the IDR process to challenge any other aspect of the survey process, such as scope and severity assessments of deficiencies, with a few exceptions: perceived inconsistencies of the survey team; or alleged shortcomings of the IDR process itself.
Regarding the IIDR process, you must request an Independent IDR within 10 calendar days of receipt of the offer and should submit the request in writing to the proper agency or entity, as appropriate.
Your request also should include copies of any documents such as facility policies and procedures, resident medical record information that is redacted for confidentiality, and other information useful in disputing the survey findings.