One-story check — admission #
Resident: _______________ · ARD: _______________ · HIPPS: _______________
Physician EMR
- Principal diagnosis matches MDS Section I
- NTA diagnoses active in look-back with treatment
- Certification describes skilled need
Nursing EMR
- ADL notes match GG assist levels
- Care plan problems match highest case-mix drivers
- No contradiction with BIMS / mood scores
Therapy EMR
- Minutes and signatures match billed category
- Functional scores align with GG
- Medical necessity documented per session
MDS
- Every payment driver has dated source in look-back
- No history-only codes checked active
- Pre-lock checklist signed
Pass / Fail: _______________ · Owner: _______________ · Due: _______________