Appendix · The Medicare Triple-Check (before each Part A billing cycle)
Beyond the per-note pre-flight, run a Triple-Check with lead time before every Part A billing cycle — it is where coverage, coding, and compliance are reconciled.
Dimension
Confirm
Billing / eligibility
Qualifying 3-day inpatient stay verified (occurrence span code 70) or the applicable waiver documented; benefit-period days correct; MA/authorization confirmed if applicable
Clinical / PDPM
The MDS is supported by the record; the PDPM components (function, NTA, nursing, therapy) are each defensible; skilled daily documentation is present for every billed day
Compliance
Physician certification/recertification signed and dated within the required windows; notices (SNFABN/NOMNC) issued and documented where coverage changed or ended; exceptions resolved, not overridden
