SNF Billing Compliance Audit Template — PDPM & MDS 3.0
SNF Medicare Part A Compliance Audit TemplateA structured, fillable audit template for SNF billing coordinators, MDS coordinators, and compliance staff managing Medicare Part A billing under PDPM.If your facility transitioned from RUG-IV to PDPM in 2019, but your documentation strategy has not fully transitioned with it, this template helps reveal exactly where the exposure is.This template helps skilled nursing facilities, billing coordinators, MDS coordinators, compliance staff, and contracted auditors review Medicare Part A documentation before an audit arrives or during an active claim review.What’s InsideThis fillable PDF audit template includes 5 structured sections:Section 1 — Pre-Audit Readiness ChecklistA detailed checklist covering key SNF audit risk areas, including:Medicare Part A Eligibility & Qualifying Stay3-day inpatient stay, observation day exclusion, 30-day admission window, physician certification and recertification schedule, and 100-day benefit period.MDS 3.0 Assessment Accuracy & Timing5-Day ARD window, quarterly and annual assessment schedule, SCSA triggers, and transmission before billing.PDPM Classification AccuracyPT, OT, SLP, Nursing, and NTA component accuracy, ICD-10 specificity, Section GG functional scores, and HIPPS code match.Skilled Care DocumentationDaily skilled nursing notes, therapy treatment notes, measurable goals, and avoidance of template-only notes.Consolidated Billing CompliancePart B services during a Part A stay, outside provider billing, and ancillary services.Medicare Conditions of ParticipationABN, NOMNC timing, SNFABN, resident rights, and staff credential documentation.Section 2 — Claim-Level Audit WorksheetA structured table to document findings for each SNF claim reviewed.Includes SNF-specific error code references for:MDS timing issuesPDPM classification errorsHIPPS mismatchesConsolidated billing violationsSkilled care documentation gapsNotice timing issuesSection 3 — PDPM Component Quick ReferenceA practical PDPM reference covering all five payment components:PTOTSLPNursingNTAIncludes key MDS drivers and the primary audit risk for each component.Also includes a Variable Per Diem Schedule showing:PT/OT taperNTA 300% adjustment for days 1–3Section 4 — Top 10 SNF Denial Triggers & FixesThe most common PDPM-specific audit findings, paired with specific corrective actions.Topics include:MDS timing violationsSection GG documentation gapsNTA inflationNOMNC timing failuresHIPPS code mismatchesSkilled care documentation gapsConsolidated billing errorsQualifying stay issuesUse this section to identify preventable errors before they become denials, recoupments, or compliance findings.Section 5 — Documentation Requirements ChecklistA practical documentation checklist organized by phase:AdmissionOngoing during stayDischargeUse it to confirm the record supports the Medicare Part A stay before submission or audit review.Section 6 — Corrective Action Plan TemplateA pre-formatted Corrective Action Plan template for major SNF finding categories, including:MDS timing and accuracyPDPM classificationSkilled care documentationNTA and SLP codingConsolidated billingQualifying stay and noticesBest Used ForSNF Medicare Part A self-auditsPDPM documentation reviewsMDS timing and accuracy checksHIPPS code reconciliationSection GG documentation auditsSkilled care documentation reviewsConsolidated billing compliance checksNOMNC and SNFABN notice reviewsCorrective Action Plan preparationInstant AccessOne-time purchase.Instant PDF download.Fillable template format.Need All 7 Specialties?The complete Healthcare Biller’s Compliance Audit Vault includes all 7 specialty-specific templates for $297.DisclaimerNot legal advice.For operational compliance use only.© Kent Strategic Solutions | Healthcare Biller’s Compliance Audit Vault
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