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  • Cms Cmp Analytic Tool Amp Guidance - Wahsa

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Long Term Care (Health and Life Safety Code) Civil Money Penalty (CMP) Analytic Tool Calculation Worksheet For Use by CMS Regional Office Staff ONLY Provider Name: CCN # Cycle Start Date RO CMP Case.

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How to fill out the CMS CMP Analytic Tool Amp Guidance - Wahsa online

This guide provides a comprehensive, step-by-step approach to filling out the CMS CMP Analytic Tool Amp Guidance - Wahsa. Whether you are a user with limited experience or more familiar with digital document management, this guide will help you navigate the online process efficiently.

Follow the steps to successfully complete the analytic tool online.

  1. Press the ‘Get Form’ button to obtain the form and access it in the online editor.
  2. Fill in the provider name in the designated space at the top of the form.
  3. Enter the CCN number and cycle start date as specified.
  4. Input the name of the CMP case analyst and the current date.
  5. Begin with Part I and select the CMP type by checking either 'Per Day' or 'Per Instance' based on the given criteria.
  6. For the selected CMP type, mark all applicable reasons in the provided checklists.
  7. In Section 2, indicate the start date for the Per Day CMP. Document the date of noncompliance as required.
  8. Refer to Section 3 for the CMP grid and choose the appropriate base amount based on the identified severity level of deficiencies.
  9. In Section 4, indicate any history of facility noncompliance and choose an amount to add based on the S/S pattern.
  10. Complete Section 5 if applicable, adding amounts for repeated deficiencies under the PD CMP guidelines.
  11. Proceed to Section 6 and input any amounts related to Substandard Quality of Care deficiencies as indicated.
  12. In Section 7, report the total number of F or K tags contributing to the CMP and add corresponding amounts.
  13. For Section 8, evaluate culpability and add the appropriate amount based on the highest S/S cited.
  14. Once all sections are filled out, review the calculated baseline CMP amount.
  15. In the adjustments section, check for any necessary adjustments to the calculated CMP amount as outlined.
  16. Finalize the form by summarizing the total CMP assessed and determining the final amounts based on any applicable discounts.
  17. Save your changes, and choose to download, print or share the completed form as needed.

Complete your documents online today to ensure compliance and efficient management.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232