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Audit of Nursing Homes' Nurse Staffing Hours Reported in CMS's Payroll-Based Journal

Announced on  | Last Modified on  | Project Number: A-09-24-02005
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Nursing homes are required to electronically submit complete and accurate direct care staffing information to CMS’s Payroll-Based Journal (PBJ) system on a quarterly basis.  Direct care staff include nurse and non-nurse staff who, through interpersonal contact with nursing home residents or resident care management, provide care and services to residents to allow them to attain or maintain the highest practicable physical, mental, and psychosocial well-being.  CMS and other stakeholders use the staffing information in the PBJ to: (1) measure nursing home performance, (2) better understand the relationship between nursing home staffing levels and the quality of care that nursing homes provide, (3) identify noncompliance with Federal nurse staffing regulations, and (4) facilitate the development of nursing home staffing measures.  We will review the nurse staffing hours reported in the PBJ to determine whether the reported hours are accurate.

TIMELINE

REPORT PUBLISHED

CMS’s Processes Were Not Effective in Ensuring the Accuracy of Staffing Information Reported in the Payroll-Based Journal (A-09-24-02005)

26-A-09-076.01 to CMS - Open Unimplemented
Update expected on 12/16/2026
We recommend that CMS consider the results of our audit when selecting nursing homes for followup audits by the CMS PBJ auditor.

26-A-09-076.02 to CMS - Open Unimplemented
Update expected on 12/16/2026
We recommend that CMS require the CMS PBJ auditor to verify whether nursing homes have taken corrective actions on findings identified in prior PBJ audits.

26-A-09-076.03 to CMS - Open Unimplemented
Update expected on 12/16/2026
We recommend that CMS educate nursing homes on the updated guidance available in the PBJ Policy Manual and PBJ Policy Manual FAQs.

26-A-09-076.04 to CMS - Open Unimplemented
Update expected on 12/16/2026
We recommend that CMS regularly communicate to nursing homes the trends in CMS PBJ audit findings (e.g., by providing information on frequently identified CMS PBJ audit findings during an Open Door Forum and on the PBJ web page).

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Nursing Homes, Nursing Facilities, and Assisted Living Facilities
Target Groups
-
Financial Groups
Medicaid Medicare A