Five-day PPS assessment completeness
All required MDS items for PDPM classification are present and coded per the RAI Manual — no skipped fields, no contradictory entries.
The most rigorous PDPM pre-bill validation a skilled nursing facility can get.
The SNF PDPM Pre-Bill MDS Validation Engine assembles a documentation-complete validation report — every PDPM component, every required MDS item, the evidence index, the correction list, and the audit-ready file — checked against the RAI Manual and PDPM mapping tables before a certified MDS nurse reviewer releases it.
Every PDPM component: PT, OT, SLP, Nursing, NTA, Non-Case-MixRAI Manual v1.18.11 and PDPM mapping tables, gate-checkedCertified MDS nurse reviewer (RAC-CT) release on every report24-hour turnaround from complete intakeAudit-ready evidence index included
Why validations fail
A single miscoded MDS item can cost $50–$175 per day — or trigger an extrapolated recoupment.
Every Medicare Part A per-diem dollar flows through the MDS assessment. Miscode a primary diagnosis, miss an NTA comorbidity, or leave a nursing component unsupported — and the facility either leaves money on the table or invites an audit that can demand millions back. The SNF improper payment rate hit 17.2% in 2024, up from 7.79% in 2021. CMS ran a nationwide 5-Claim Probe & Educate on every SNF. The OIG has launched a PDPM audit series; the first target was asked to repay $31.2 million on extrapolation.
Most facilities validate by relying on a single overworked MDS coordinator — a role with ~60% annual turnover. There is no independent check. Errors are silent until a MAC shows them to you.
The SNF PDPM Pre-Bill MDS Validation Engine exists to close that gap with a single, exhaustive standard applied identically to every assessment.
17.2%
SNF improper payment rate in 2024 — up from 7.79% in 2021
The benchmark
Measured against the RAI Manual and PDPM mapping tables — item by item.
We do not summarize the rules and hope. Every report is scored against a versioned rule pack tied to the exact text of the RAI Manual and CMS PDPM mapping tables. These are the provisions each report is held to.
Primary diagnosis mapping accuracy
The primary diagnosis ICD-10 code is mapped to the correct clinical category (PT/OT, Nursing, SLP) per the latest CMS mapping tables — a single error can swing $50–$175/day.
NTA comorbidity capture
All Non-Therapy Ancillary (NTA) comorbidities present in the medical record are identified and coded — missed comorbidities cost $300–$1,200 per stay.
Nursing case-mix index accuracy
Nursing component items (e.g., ADL score, depression, pain) are supported by the clinical record and correctly map to the nursing case-mix group.
SLP comorbidity and swallowing
Speech-language pathology comorbidities and swallowing disorders are captured per the record and mapped to the correct SLP clinical category.
Documentation support for each PDPM component
Every MDS item driving payment is cross-referenced to a source document in the medical record — an audit-ready evidence index is produced for each assessment.
How a report is built
Intake to certified nurse reviewer release, with deterministic gates the AI cannot overrule.
AI extracts and drafts. Deterministic rules — running as code, outside the model — decide what is complete. A certified MDS nurse reviewer (RAC-CT) signs every release. That order is never reversed.
01
Free 5-assessment Accuracy Scan
Upload your MDS assessments and corresponding medical records. We return a free accuracy read: which PDPM components are correctly coded, which are at risk, and which documentation gaps exist.
02
Record ingestion & extraction
As your authorized clerical agent, we ingest the MDS assessment, physician orders, nursing notes, therapy notes, and hospital records — extracting all items relevant to PDPM classification.
03
Grounded PDPM mapping
The AI maps each ICD-10 code, comorbidity, and functional score to the PDPM clinical categories using the latest CMS mapping tables — no invented facts, no guesswork.
04
Deterministic completeness gates
Every MDS item driving payment is checked against the medical record. Missing documentation, unsupported codes, and mapping errors are flagged. Any discrepancy blocks release until resolved.
05
Certified nurse reviewer release
A certified MDS nurse reviewer (RAC-CT) reviews the exception queue, validates clinical plausibility, and signs the report. High-dollar or complex assessments route to a senior reviewer.
06
Delivery
You receive the validation report: PDPM component-by-component accuracy verdict, specific correction recommendations, documentation-gap list, audit-ready evidence index, and monthly facility scorecard — ready for your MDS coordinator to act on.
The bar we hold
Rigor you can measure.
100%
Certified nurse reviewer-released
No report ships without a human signature.
24 hours
Standard turnaround
From complete intake to released report.
<1%
Critical-defect target
Tracked against a gold-standard report library.
6
PDPM components validated
PT, OT, SLP, Nursing, NTA, Non-Case-Mix — every applicable component.
Why the SNF PDPM Pre-Bill MDS Validation Engine
Built to be the most thorough option a facility has.
Documentation-complete, by design
The deliverable is completeness itself — every PDPM component and MDS item accounted for or explicitly exception-coded. Nothing is left implicit.
Deterministic, not vibes
The gates that decide completeness are code, not a model's opinion. A mapping error cannot slip past a PDPM table check.
In its lane, on purpose
We prepare validation reports and run record reviews as your clerical agent. We never contact the resident, give legal advice, or bill Medicare directly.
Engagement
Flat fee, per validated assessment. No contingency, ever.
Simple, predictable, and aligned with a documentation standard — not a cut of any recovery.
- A free 5-assessment Accuracy Scan before you commit — see exactly what is at risk.
- One flat fee per validated assessment; disclosed pass-through costs for any outsourced record retrieval.
- Optional fixed-fee senior reviewer escalation for complex or high-dollar assessments.
- Optional Monthly Facility Scorecard add-on for ongoing capture-rate and error-rate tracking.
FAQ
Questions, answered precisely.
Is the SNF PDPM Pre-Bill MDS Validation Engine a law firm?
No. The SNF PDPM Pre-Bill MDS Validation Engine, a service of Your Deputy, Obuke LLC, provides documentation-completeness services. It is not a law firm, does not provide legal advice, and does not represent you in any legal matter. Attorney review is available and recommended for any contested or high-value matter.
Do you contact the resident or bill Medicare?
Never. The Engine is not a billing service and does not contact residents or their families. The facility remains the Medicare provider and the party responsible for submitting claims and communicating with residents.
What makes a report 'complete'?
Completeness is defined by the RAI Manual and PDPM mapping tables: every PDPM component validated, every MDS item driving payment cross-referenced to the medical record, and all discrepancies flagged. Deterministic gates enforce each one before release.
How fast is it?
The standard turnaround is 24 hours from complete intake to a certified nurse reviewer-released report. The free Accuracy Scan is returned much sooner and tells you exactly what is at risk.
How are you priced?
A flat fee per validated assessment, plus disclosed pass-through costs. No contingency and no percentage of any recovered amount or increased reimbursement.
See what's at risk before your next audit.
Start with a free 5-assessment Accuracy Scan. Send your MDS assessments and medical records and we'll return an accuracy read against every PDPM component.
Documentation-completeness service · not legal advice · the facility submits every claim.