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A finding of immediate jeopardy in a CMS survey is the worst fear of peer review professionals, and rightly so. This survey finding puts you on a fast track to losing your Medicare participation and CMS won’t wait long for you to correct the problems.
Immediate jeopardy is the most severe finding by a CMS surveyor, after the “standard” and “condition” levels. The standard level is when the surveyor finds noncompliance with one or more requirements that do not substantially limit the facility’s ability to furnish adequate care and would not adversely affect health and safety if it were to continue. (More information on CMS definitions and instructions to surveyors is available online at http://tinyurl.com/o6ddnv3.)
The next step up is the condition level, involving noncompliance with either one standard representing a severe health and safety breach or several standards that together pose a severe risk. CMS lists five deficiencies that will result in an automatic condition level citation: restraint and seclusion failures, lack of a utilization review program, alcohol gel leading to a fire risk, failure to provide adequate emergency services, and any other problem causing an immediate threat to health and safety.
And there is immediate jeopardy. For this citation, a surveyor must document noncompliance with one or more requirements of participation that has caused or is likely to cause, serious injury, harm, impairment, or death to a patient.
With that citation, everything speeds up and the stages get much higher. Whereas you normally would have six months to remedy compliance deficiencies, an immediate jeopardy finding means your provider agreement could be terminated in as little as two days. (But at least one has to be a work day.) The longest CMS will wait is 23 days.
However, CMS does not expect you to correct the overall deficiency in that time. You only have to “abate the jeopardy,” which means eliminating the immediate threat to patient safety. When CMS determines that the immediate jeopardy has been removed, you have the standard six months to correct the underlying deficiency.
Immediate jeopardy also may result in state monitoring, which can begin immediately. Other remedies such as denial of payment for new admissions, imposing temporary management, and directed in-service training can be applied with only two days’ notice.
An immediate jeopardy citation can be appealed through the informal dispute resolution process the same as any other deficiency finding, and you can file a formal appeal with an administrative law judge. In addition to disputing the surveyor’s deficiency finding, you can dispute the severity of the deficiency so that it is reduced to less than immediate jeopardy.