There is still time to improve performance this year, but only if teams understand where they stand now and begin tightening the process.
Facilities that are underperforming on APU are not out of options, but they are running out of time to rely on delayed follow-up, incomplete review, or last-minute cleanup. There is still time to improve performance this year, but only if teams understand where they stand now and begin tightening the process immediately.
Last year, more than 2,000 facilities lost the 2% APU update. Some fell below the required SNF QRP submission threshold. Others failed required NHSN reporting. Either way, the result was the same: lost reimbursement tied to reporting processes that were not managed closely enough.
And the issue is not behind us. We recently had another operator reach out for help after two facilities in its group incurred the 2% APU reduction for FY 2026, and leadership was not fully sure why. After engaging Polaris Group for support, Amanda Earp, Nurse Consultant and Medicare expert, worked with the team to identify the issue step by step by teaching them which reports to pull, how to use the Error Detail Report, which APU items affect the threshold, and how to determine whether dashed items could be corrected for CY 2025 fourth quarter based on documentation already in the record. Just as important, the work did not stop with corrections. The team was also educated on the documentation needed going forward so the same items would be less likely to be dashed in future submissions. That gave the client both a clearer understanding of what had happened and a more practical path to prevent it from happening again.
The financial impact adds up quickly. For a facility with $5 million in annual Medicare revenue, a 2% APU reduction means about $100,000 in lost reimbursement. At $10 million, that becomes a $200,000 hit. That is why APU performance should not be treated as a year-end compliance issue. It needs to be tracked and managed throughout the year.
The first step is to know where the facility stands now. That sounds simple, but in practice many teams do not know which reports to pull to establish a baseline, what those reports are showing them, or what should be monitored each month. Even on startup calls, facilities often do not know where they are with their APU threshold or how to access the information they need in iQIES.
The starting point is the SNF QRP Provider Threshold Report. That report shows the number of MDS assessments submitted, the number submitted complete, and the resulting completion percentage. Just as important, it tells the facility whether it is currently tracking above or below the compliance line. If leadership and the MDS team are not reviewing that report regularly, they may not realize how much risk exists until much later in the year, or until they are notified that the APU penalty has already been applied.
The Review and Correct Report helps facilities move from awareness to action. It allows the team to identify incomplete or unaccepted records, pinpoint where missing data still exists, and work those issues before they become a bigger problem. But the larger value is operational. It helps facilities see patterns, understand where dashes are occurring, and determine whether those items can be corrected based on documentation in the record. Amanda’s guidance to this recent client went beyond simply saying “fix the errors.” The team was shown which reports to run, which error codes to use, how to crossmatch dashed items against the applicable APU reporting elements, and when a modification was appropriate. That is the shift facilities need to make. The goal is not just to clean up dashes after the fact. It is to build the knowledge, oversight, and documentation habits that prevent them in the first place.
This work may become even more important soon. In the FY 2027 SNF PPS proposed rule, CMS is proposing to shorten the quarterly reporting timeline. If finalized, that would leave facilities significantly less time to identify missing data, make corrections, and improve submission completeness. Facilities that are still depending on delayed review and end-stage cleanup may find that approach much harder to sustain.
The good news is that improvement is possible.
In one facility we supported, the threshold report improved from 73% in December to 81% by mid-March. That facility was operating with interim DON support rather than permanent nursing leadership, which makes the progress especially notable. They are not where they need to be yet, but the movement itself matters. It shows what can happen when the right support, structure, and follow-up are put in place.
As Kim Steele, Polaris Group MDS Coordinator, explained, “We spent quite a bit of time showing them where to find reports and how to read them.” That kind of education is often where improvement begins. Many teams are not ignoring the issue. They simply have never been taught which reports matter, how to interpret them, or how to use them consistently enough to prevent problems before deadlines get close.
Steele described the change in simple terms: “They went from 4 pages of dashes down to like a page.” That kind of movement reflects more than chart cleanup. It reflects better oversight, stronger follow-up, and a team that is learning how to support the documentation needed to avoid dashes in the first place.
In another facility Kim supported, the threshold report improved from 73% in December to 98% by mid-March. That kind of turnaround does not happen by accident. It reflects education, guidance, and a team that was willing to respond to coaching and tighten its process. It is also a reminder that strong outsourced MDS support can do more than stabilize compliance. It can change performance quickly.
That willingness mattered. As Steele put it, “These team members … are hungry to do it right.” She also noted, “If they don’t understand, they ask again… they don’t let it go till they get it.” That is where education turns into performance improvement. When a facility team is engaged and supported, the process becomes stronger and the results begin to move.
Steele’s experience highlights the real driver behind these gains: consistent oversight paired with practical education. The improvement did not come from simply telling teams to do better. It came from showing them what to look at, helping them understand where the breakdowns were occurring, and putting processes in place to make sure the documentation needed to avoid dashes was completed consistently.
These examples reinforce an important point: low APU performance is not always a sign that staff are not trying. More often, it reflects gaps in education, oversight, report monitoring, and the day-to-day processes needed to ensure required documentation is completed consistently enough to avoid dashes.
For some facilities, the issue is not the absence of an MDSC. It is the need for stronger oversight, better education, clearer follow-up, and more discipline around report monitoring and correction. In those situations, focused consulting support may be the right solution.
For others, the challenge is more fundamental. If the facility is struggling to recruit, retain, or stabilize the MDS Coordinator role itself, outsourced MDS support may be the better fit.
For facilities that lost APU, are hovering too close to the compliance line, or simply are not confident in what their reports are showing, now is the time to act. Waiting until deadlines are near only makes recovery harder.
Facilities do not need perfect conditions to improve. They need a clear starting point, the right reports, consistent follow-up, and support that turns findings into action.
If your facility already has an MDSC in place but needs stronger oversight, education, and process discipline, Polaris can help through focused consulting support. If the challenge is finding or stabilizing the MDS Coordinator role itself, our outsourced MDSC program can provide the leadership and consistency needed to improve performance before missed opportunity becomes lost reimbursement.
