Bringing transparency to federal inspections

The CMS-2567 form comprises two main elements: a statement of deficiencies written by inspectors on behalf of the Centers for Medicare and Medicaid Services (CMS) and a plan of correction written by the hospital. The overall purpose of the form is to document findings of non-compliance with Medicare rules.

The form uses a standard format to document any deficiencies identified during an inspection, what each deficiency was and the evidence of the deficiency. It also provides a standard format for hospitals to describe plans to correct deficiencies. The CMS-2567 is a public document. Federal law requires these forms be made available to the public within 90 days of any survey.

It is used by CMS, state health departments, hospitals, purchasers, consumers, advocacy groups, journalists and the public as a source of information related to quality of care and compliance with Medicare’s Conditions of Participation.

For more information, please see the Q&A with Medicare about the contents of the form.

Key elements in the CMS-2567:

Provider number – The unique official provider number used by the Centers for Medicare and Medicaid Services.

Building information – If the facility has multiple buildings or wings, these might be identified here.

Name and address of facility – Identifies the official name and address of the facility. If multiple sites are inspected using the same identification number, this identifies the site where a deficiency exists.

Summary of deficiencies – This area identifies each cited deficiency, including the specific regulation violated, followed by a narrative summary. The narratives do not identify patients or hospital staff members by name.

Plan of correction – In this column, the facility explains its plans for correcting the identified problems and the anticipated time of correction. Ordinarily, the provider is expected to take the steps to achieve compliance within 60 days of notification; however, additional time may be allowed. [Plans of correction, which are the responses made by hospitals to any cited deficiencies, have not been released in an electronic format by CMS. You will need to request a plan from CMS or directly from a hospital.]

Prefix tags – A short-hand code to refer to the regulations violated by the hospital.

Completion date – The anticipated time of correction, whether in the past or the future.

Signature – This form should be signed and dated by a representative of the facility.