Significance of Documentary Evidence in Determining

3026 - Significance of Documentary Evidence in Determining Noncompliance (Rev. 1, 05-21-04) The RO uses the following documentation in determining compliance with the Medicare Federal CoPs or CFCs or Requirements of Participation. 3026A - Statement of Deficiencies (Rev. 1, 05-21-04) This statement constitutes evidence that the provider/supplier was notified of the specific deficiencies. These deficiencies are to be written as required by the Principles of Documentation. This assures that the statement provides accurate descriptions of the deficiencies and interpretations of Federal Medicare requirements that are not met. Otherwise, it might be alleged at a hearing that the termination action was based on error. 3026B - Plan of Correction (PoC) (Rev. 123, Issued: 10-03-14, Effective: 10-03-14, Implementation: 10-03-14) When a PoC has been found to be unacceptable by the SA or RO, the PoC presents evidence that the provider or supplier is unable or unwilling to achieve compliance in a reasonable amount of time. If a provider or supplier disagrees with a SA or RO finding of a cited deficiency, the provider or supplier may, in lieu of submitting a PoC, state on Form CMS-2567 the factual basis for disagreeing that a deficiency occurred. Whenever possible, the provider or supplier must reference the specific regulatory provision involved in the disputed issue and what factual evidence was available at the time of the survey to demonstrate compliance. It is not acceptable for the provider or supplier to provide evidence of corrective actions taken after the survey started as a basis for removal of a deficiency citation. It also is not acceptable for the provider or supplier to base its disagreement on a different interpretation of the regulatory requirements than that found in CMS guidance. The original termination date is not changed by the provider’s or supplier’s disagreement with one or more of the deficiency citations. The RO reviews all of the documentation, including the survey findings and the documentation presented by the provider/supplier before making a determination. (If the RO determines that a deficiency did not exist, it is removed from Form CMS-2567.) 3026C - Revisit Reports and Subsequent Statements of Deficiencies (Rev. 1, 05-21-04) This is the SA’s report of any revisit that was made to the provider/supplier following the survey that found the provider/supplier out of compliance. 3026D - SA Certification (Completed Certification and Transmittal (Form CMS-1539)) (Rev. 1, 05-21-04) This is the SA’s certification as to whether the Medicare health and safety requirements were met at the time of survey. It also indicates that the SA completed the required actions and decisions. 3026E - Survey Reports (Rev. 1, 05-21-04) Survey reports are the surveyor’s written records of findings during surveys that are primary evidence for the RO’s determination. 3026F - Documents of Collateral Evidence (Rev. 1, 05-21-04) When obtainable, the RO adds such items as copies of pertinent provider records, correspondence, and State licensure information to the termination file to resolve or forestall conflicts of factual information elsewhere in the file and to support the adverse findings in the determination. Documentation can include verified complaint information. 3026G - Notice of Termination (Rev. 1, 05-21-04) An adjudicative determination is consummated in an official notice of determination given to the parties whose rights are at issue. The determination becomes official when the notice (the formal termination letter) is mailed. It is essential that the notice be correct, not only in its procedural rendition, but also in the substance of the decision reported, since the receiving entity, as well as appellate authorities and courts, will treat it as the official “determination.”