Problem: Which of the following is a way the Five Star rating can indirectly impact revenue for the nursing facility? Five Star cannot impact revenue indirectly. Consumers and referral sources decide which SNF provider to use based on Five Star ratings, therefore impacting the SNF's census. Ratings below 2 stars in any category result in a Civil Monetary Penalty issued by the state survey agency. CMS will reduce the daily per diem rate by 2% for ratings below 3 stars.