Discrepancy Report

Discrepancy Report Process

On occasion, a survey vendor may identify discrepancies from CAHPS Hospice Survey protocols that require corrections to procedures and/or electronic processing to realign the activity to comply with CAHPS Hospice Survey protocols. Survey vendors are required to notify CMS of these discrepancies immediately upon discovery.

Review Process

The CAHPS Hospice Survey Project Team will review the Discrepancy Report to assess the actual or potential impact of the discrepancy on reported CAHPS Hospice Survey results. Notification of the outcome of the review may not be forthcoming until all the data for the affected reporting periods have been submitted and reviewed, and the impact of the discrepancy has been ascertained. Email notification will be distributed to the organization submitting the Discrepancy Report once the outcome of the review has been determined.

Discrepancy Report Form

The Discrepancy Report Form must be completed and submitted online on the CAHPS Hospice Survey Web site (www.hospicecahpssurvey.org). The requested information regarding the affected hospices must be provided in Section III in order to complete the CAHPS Hospice Survey Discrepancy Report. All required fields are indicated with an asterisk (*). If all of the information is not immediately available, survey vendors must submit an initial Discrepancy Report alerting CMS of the issue and subsequently update the Discrepancy Report with the remaining required information once available. When updating a Discrepancy Report, please note that the initial report is retained in its entirety; therefore, it is necessary only to provide the remaining required information pertaining to the original submission, referencing the Original Report Form ID.

NOTE: This form does not accept any special characters or symbols in the text boxes. Use only alphanumeric characters when completing this form.

NOTE: Please print completed Discrepancy Report Form before submitting to keep a copy for your records.

Indicate whether this report is an Initial Discrepancy Report or an Updated Discrepancy Report.

Initial Discrepancy Report * (Must be submitted within 24 hours after the discrepancy has been discovered.)

Updated Discrepancy Report * (If needed, must be submitted within two weeks of initial Discrepancy Report.)

Date of initial Discrepancy Report submission * Date of initial Discrepancy Report submission is required.

Initial Discrepancy Report ID * The Initial Discrepancy Report ID is required.

1. General Information

Unique Report ID 20073

Submission Date 12/21/2024

1a. Name of Organization submitting the Discrepancy Report * The Name of the Organization is required.

2. Contact Person for this Discrepancy Report (Confirmation email will be sent to the Contact Person.)

2a. First Name * First Name is required.

2b. Last Name * Last Name is required.

2c. Mailing Address 1 * Mailing Address 1 is required.

2d. Mailing Address 2

2e. City * City is required.

2f. State * State is required.

2g. Zip Code * Zip Code is required.

2h. Telephone * Telephone is required.

Extension

2i. Fax Number

2j. Email * Email is required.

3. List of Hospices Applicable to this Discrepancy

3a. Total Number of Affected Hospices * The Number of Affected Hospices is required.

3b. Add the information for the affected hospices by populating the following 6 fields. A hospice may be added more than once if there are multiple time frames for the hospice. It is important that the effects of the Discrepancy Report are quantified.

CCN (Must be 6- characters, no hyphen) * CCN is required. The first position must be an alphanumeric. Only the first position can be alphanumeric. Cannot have any hyphens. The third position must be a 1. Too few characters. Must be 6 characters Too many characters. Must be 6 characters

Name of Hospice * Name of Hospice is required.

Reset

Decedent Month and Year of death * --> Decedent Month and Year of death is required.

Discrepancy category * Discrepancy Category is required.

Total Eligible Decedents/Caregivers Affected for this CCN * Number of Eligible Discharges Affected is required. Must be up to 7 characters

Total Sampled Decedents/Caregivers Affected for this CCN * Count of Sampled Patients affected is required. Must be up to 7 characters

Add

Edit

Cancel

(click on a row in the grid to edit it)

4. Information about the Discrepancy

4a. Description of the discrepancy * Description of the discrepancy is required. {{2000 - model.DiscrepancyDescription.length}} characters remaining

4b. Description of how the discrepancy was identified * Description of how the discrepancy was identified is required. {{2000 - model.DiscrepancyIdentified.length}} characters remaining

4c. Description of the Corrective Action to fix the discrepancy, including estimated time for implementation * Description of the Corrective Action is required. {{2000 - model.CorrectiveAction.length}} characters remaining

4d. Additional information that would be helpful that has not been included above * Additional Info is required. {{2000 - model.AdditionalInfo.length}} characters remaining

Enter answer to equation on left.

Note: Please print completed Discrepancy Report form before submitting.

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CAHPS® Hospice Survey

Discrepancy Report

CAHPS^® Hospice Survey