PDPM
FORMS
CAREPLANS
ACTION CODES
CERTS
100

How many categories make up your PDPM rate?

What is 6? (nursing, PT, OT, ST, NTA, base rate)
100

This form supports the skilled ongoing stay for the resident by IDT.

What is the weekly CSR form?

100
This is an impact on specific issues, conditions or risks of issues.

What is a Care Area Trigger?

100

Room Change

What is RC?

100

This is what you must fill out if your MD signs your certification late.

What is DELAYED PHYSICIAN CERTIFICATION AND RE-CERTIFICATION 

200

Spondylosis will give you more money in this category.

What is NTA?

200

This is where the physician certifies that a diagnosis is current.

What is the Physician Diagnosis Verification form?

200

This is the time frame in which your comprehensive careplans must be completed by.

What is by day 21 from admission?

200

Discharge Date?

What is DD?

200

This is when the 3rd certification if due?

What is no later than the 30th day from previous recertification signature date?

300

This BIMS score is considered Cognitively Impaired.

What is 12 or below?

300

This serves as the attestation for collaboration of section GG for the first three days.

What is the Admission CSR?

300

This includes the parts: Subject, Verb, Modifier, Time Frame and Goal.

What is care plan goal statements?

300

Return from ER

What is RER?

300

Why is it important to include any skilled nursing services as well as rehab when rehab is the main thing skilling the patient.

What is if rehab is denied we have nursing skilled documentation to support the claim?

400

This is the lowest paying SLP category.

What is SA?

400

In lieu of a medical diagnosis (one doesn’t exist) this will support a point for the NTA category.

What is the At risk for malnutrition form?

400

This is how you prove a medical condition or diagnosis is ongoing and requires treatment or observation?

What is a careplan?

400

Deceased Date (in Hospital)

What is DH?

400

Straight Catheterizations, unstable DM, cardiovascular compromise, circulation problems, medication adjustment, malnutrition, and respiratory therapy?

What is a nursing skilled reason for medicare coverage?

500

This GG Item is excluded from the nursing function score?

What is oral hygeine or walking items?

500

This form will provide you a list of all documents to support the HIPPS code.

What is the MDS Form?

500

Sample: Rose will verbalize appropriate intervention to minimize the risk for falls.

What is a goal?

500

Leave of Absence/LOA

What is L?

500

This is where a cert should be housed for each resident at least 3o days prior to discharge.

What is the document section in PCC?

M
e
n
u