We often get asked the “Why Me?” question when a facility gets audited.  Unfortunately, there’s very little disclosure from CMS on the triggers and reasons for PBJ audits. Even the associations are unable to learn much about PBJ audits.

So let’s change that! Complete the first-ever PBJ Audit Survey here or by clicking the below button. We’ll compile and share the results with you and your peers.

What do we know about PBJ audits?

As we review PBJ audits of our customers, we have noticed a few patterns.  Our completely unscientific observations about PBJ audits include:

• Some 2% to 5% of submissions get audited every quarter
• The response window is very short – 7 days
• Expect around 30 detailed questions about your practices and policies
• You have to provide supporting documentation to back up your PBJ report
• Audits may be Full or Targeted
• Full audits appear to be random

The last round of PBJ audits that came out in early October, and some included a bonus question which we think may indicate the “trigger” for that particular audit.  There were two common questions repeated multiple times in our reviews:

1)  Significant Increases in Hours Per Resident Day
When Nursing Hours Per Resident Day increased by 15% or more, this question was asked – including the calculation for that facility.  We saw increases from about 15% to well over 30% in the audits, and the threshold may be lower than the 15% seen in our unscientific sample.

2) High Hours Per Resident Day
When a facility’s Nursing Hours Per Resident Day was higher than the majority of facilities, the next question was asked.  We only saw this question when the HPRD was over 6.0

Share your experience

The form below is for those facilities who’ve experienced a PBJ audit and are comfortable sharing their experience with their peers.  Your responses will be kept completely anonymous and will be compiled into a single summary report for those who request it.