Submit the completed form along with all required documentation via email to medicaresubmissions@example.com, fax to 123-456-7890, or online at www.medicare-submissions.com/form-submit. For physical mail, send to Medicare Submissions, 123 Healthcare Lane, Medical City, State, 12345. Ensure that all forms are signed, dated, and complete before submission to avoid delays.

Ensure the checklist is reviewed and submitted before the fiscal year deadlines in 2024 and 2025 to avoid claim processing delays.

The purpose of this form is to ensure thorough and accurate documentation for Comprehensive Error Rate Testing (CERT) in Skilled Nursing Facilities (SNF). It aids in the proper submission of all required documents to support claims under the Health Insurance Prospective Payment System (HIPPS). By following this checklist, healthcare providers can reduce the risk of claim denials and ensure compliance with Medicare requirements, facilitating smoother claim processing and reimbursements.

• 1. Physician Certification: Certification and recertification by a physician.
• 2. Plan of Care: Certified plan of care by the physician, including treatment plans.
• 3. Clinical Documentation: Reports supporting functional abilities, swallowing disorders, and nutritional status.
• 4. Minimum Data Set (MDS): Complete MDS including signature pages for applicable dates of service.
• 5. Diagnostic Test Results: Test results including imaging reports.
• 6. Therapy Documentation: Documentation of therapy minutes billed and evaluation reports.
• 7. Inpatient Stay Records: Qualifying 3-day inpatient stay documentation, such as hospital discharge summary.
• 8. Medication Records: Medication administration and treatment records.
• 9. Nursing Notes: Notes from nurses detailing patient care and condition.
• 10. Physician Orders: Orders for therapy and other treatments by a physician.
• 11. Progress Notes: Notes documenting patient's progress by physician or non-physician practitioners.
• 12. Resident Care Plan: Care plan detailing the nursing facility resident's treatment and maintenance.
• 13. Skin Care Assessment: Documentation supporting skin care treatments and assessments.
• 14. Therapy Progress Reports: Reports documenting progress every 10 treatment visits.
• 15. Electronic Signature Policy: Policy and procedures for electronic signatures on records.
• 16. Signature Attestation: Completed attestation for any missing or illegible signatures.

Failure to submit this form can result in claim denials and delayed reimbursements.

• Claim Denial: Incomplete documentation can lead to denial of Medicare claims.
• Delayed Reimbursements: Missing records can cause delays in processing and reimbursement of claims.
• Non-Compliance Penalties: Failure to submit required documentation can result in non-compliance penalties.

• 1. Initial Claim Submission: When initially submitting a claim for Skilled Nursing Facility services.
• 2. Claim Appeal: When appealing a denied claim with additional required documentation.
• 3. Physician Certification: During certification and recertification of a patient's care plan by a physician.
• 4. Therapy Services: For documentation of therapy services exceeding therapy caps.
• 5. Audit Preparation: To prepare for a Medicare audit by ensuring all necessary documentation is included.