In today's complex reimbursement environment, what you document during the 7-day look-back period can make or break your PDPM accuracy — and your bottom line.

 

The PDPM New Admission Review – Nursing Component Acuity by Insight MDS & Therapy Solutions gives your MDS team a structured, category-by-category documentation review tool built specifically for Skilled Nursing Facilities navigating the nursing component of PDPM.

This three-page fillable review tool walks assessors and nursing staff through every PDPM nursing category — from the highest-intensity Extensive Services through Special Care High, Special Care Low, Clinically Complex, and Additional PDPM Considerations — ensuring no qualifying condition, treatment, or clinical indicator is missed at the time of assessment.

What this tool covers:

Detailed coding insights and documentation requirements for each Nursing Acuity Category

🫁 Extensive Services  

🏥 Special Care High 

🩺 Special Care Low 

🔬 Clinically Complex 

♻️ Additional PDPM Considerations 

For each category, your team gets:
✅ Section I qualifying diagnosis codes
✅ NTA point values clearly identified
✅ Detailed coding insights and clinical signs and symptoms to look for
✅ Specific documentation requirements , what does and does not qualify
✅ Active within 7-day lookback indicators so nothing is missed
✅ Clear guidance to prevent miscoding

This tool is the first of our series of PDPM New Admission Review Worksheets.  Soon to come are the PDPM New Admission Review- NTA Component

PDPM New Admission Interdisciplinary Worksheet- Covering the PT/OT and SLP Components in addition to GG coding and PHQ-9 

Why does accurate PDPM nursing documentation matter?
Missing or unsupported nursing categories at the time of your Assessment Reference Date can result in significant lost reimbursement that cannot be recovered retroactively. A single miscoded or undercaptured Extensive Services or Special Care High category alone can represent thousands of dollars per resident per stay. With Medicare auditors increasingly focused on PDPM accuracy and documentation support, having a structured review tool that mirrors RAI Manual language  is no longer optional , it is essential.

This tool is designed to be used at every new admission, ensuring your MDS coordinators, DONs, and nursing staff are working from the same clinical framework to capture acuity accurately, support every coded category with compliant documentation, and protect your facility from audit exposure.

This tool is a great guide for newer MDS learning PDPM hands on, to help guide what to code and how to guide your facility's teams in improving Documentation support. 

 

Final MDS coding remains the assessor's clinical judgment. This tool is a documentation guide only.

📌 Licensed for use by one facility only. Not for redistribution or resale. Full Terms & Conditions provided upon purchase.