Nursing facilities are subjected to relentless scrutiny through the survey and enforcement process. The Centers for Medicare and Medicaid Services (CMS) and state agencies, especially the Pennsylvania Department of Health (DOH), have stepped up survey and enforcement as a priority in assuring the delivery of quality health care. We take pride in our experience with the survey and enforcement process. We have aided providers in responding to both federal and state regulators and in resolving alleged deficiencies. We have closely followed the survey and enforcement system for long term care, and have taught numerous educational seminars on the enforcement systems. We provide assistance to providers in challenging deficiencies via the informal dispute resolution process as well as the state and federal independent informal dispute resolution processes. We recognize the sound business sense of resolving survey disputes professionally without relinquishing the merits of the provider's appellate rights. We bring to our clients familiarity with the regulations, the survey process, the regulators, and the administrative appeal process. We also provide advice to providers in negotiating the maze of regulations involved in the Medicare and Medicaid decertification, termination, and re-enrollment processes.