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medicare part a

Toolbox Content
  • Medicare Part A Rules : 
    • SNF  | SNF Explanation of Content  
  • PDPM Tools, Calculators and Custom Content
  • Most Current SNF PPS Proposed and Final Rules, including: 
    • Fact Sheet
    • CMS Wage Index Home Page
    • CMS Wage Index Tables
    • PDPM Changes
  • Prior Year SNF PPS Proposed and Final Rules
  • Medicare Program Integrity Manual – Chapter 6 PDPM Updates
  • For all PDPM content go to PDPM Resource Center
  • PPS MDS and Payment Schedule
  • Advanced Beneficiary Notices
    • Breakdown of Requirements for each form 
    • Appeals Process – CMS
  • What is Skilled Therapy Fact Sheet 
  • SNF Billing Fact/Reference Sheet
  • SNF Part A Certification and Recertification Requirements (for SNF stay)
  • SNF Part A Nursing Documentation to Support Skilled Care
    • Part 1
    • Part 2
  • Therapy Schedule and Minute Tracker (sample)
  • PPS 100 Day Tracker Sample 1  |  Sample 2
  • MDS Therapy Data Sheet 
  • Statistics and Report Forms 
  • ICD-10-CM Code List: LTC Therapy Most Common Codes
  • CPT Codes for PT, OT and Speech 
  • Sample Billing Logs for PT, OT, Speech
  • Medicare Part A Weekly Meeting Template 
  • Med A Triple Check Worksheet 
  • Therapy Discharge Notice (3 Day Notice to Nursing)
  • Beneficiary Notice Cheat Sheet – NOMNC, ABN

medicare part b

Toolbox Content
  • Medicare Part B Rules (SNF, Hospital Outpatient)
    • Part B Explanation of Content  
      • Evaluations | Progress Reports | Daily Treatment Encounter Note 
      • Re-Certifications | Discharge Reports 
      • CMS Therapy Documentation Fact Sheet
  • Modifiers
    • KX Modifier Threshold and Manual Medical Review 
    • MLN Matters 12397 – CO CQ Modifiers
    • CO / CQ Therapy Assistant Modifier – Decision Tree (1/1/22)
    • Proper use of Modifier 59 
  • NCCI Edits [National Correct Coding Initiative]
    • Medicare Part B Edits for SNF, CORF, OPT
    • Medicare Part B Edits for Private Practice
  • CMS NGS Link To All LCD’s
    • PT and OT Outpatient Revised LCD
      • PT and OT Coding and Billing LCD Updates
    • Speech LCD Updates 
  • Physician Fee Schedule
    • CMS Physician Fee Schedule Home Page 
    • 2023 (CY2023) Physician Fee Schedule Final Rule 
      • Federal Register Link
      • PDF Link
      • CMS Home Page Link
    • Archived Rules
      • 2022 to 2014 Final Rules
  • Physician Fee Schedule LOOK UP TOOL
  • SNF CPT Coding PT OT SLP- With AMA Definitions and Coding 
  • Advanced Beneficiary Notice Forms CMS-R-131
    • When to use and not to use 
  • Statistics and Report Forms
  • CPT Therapy Evaluation Codes
    • PT and OT Decision Chart for CPT Evaluation Codes by Complexity
    • PT Decision Chart and Documentation Tool – Eval Codes by Complexity
    • OT Decision Chart and Documentation Tool- Eval Codes by Complexity
  • Med B Triple Check Worksheet 
  • Beneficiary Notice Cheat Sheet – NOMNC, ABN
  • New/Modifications to the Place of Service (POS) Codes for Telehealth
  • Appeals Process

MDS 3.0 Tools and Resources

Toolbox Content

mDS 3.0

Current RAI manual & mDS Item Sets

  • MDS 3.0 RAI Manual v1.18.11 Final (For 10/1/ 2023)
  • MDS 3.0 RAI Manual v1.18.11 DRAFT (For 10/1/2023)
  • MDS-3.0-RAI-Manual-v1.17.1_October_2019 (Expires 9/30/23)
  • Technical Specifications MDS – Home Page
  • New MDS Item Sets for 10/1/23 (Version 6)
    • OBRA: Comprehensive   |   Quarterly
    • PPS:  5 Day Initial Medicare   |   Part A PPS DC   |   IPA
    • Other: OSA   |   OBRA DC
    • List of all Item Changes
  • List of State RAI Coordinators, Names, Emails by State
  • OSA Manual and Item Set

New MDS 10/1/2023 – Training by section

  • Understanding Changes To The MDS 3.0 For 10/1/23 (CMS)
  • Training Program Overview (CMS)
  • Section A: Social Determinants Of Health And New Data Elements (CMS)
  • Section C: Changes To Cognitive Patterns (CMS)
  • Section D: Resident Mood Interview And Total Severity Score (CMS)
  • Section GG: Summary Of Changes (CMS)
  • Section J: Health Conditions (CMS)
  • Section K: Swallowing / Nutritional Status (CMS)
  • Section N: Medications (CMS)
  • Section O: Special Treatments, Procedures And Programs (CMS)
  • Section Q: Participation In Assessment And Goal Setting (CMS)


custom tools

  • Montero Section GG Data Collection Tool to Determine Usual Performance: Used to support MDS coding
  • Section O Therapy Days and Minutes
    • Interpretation of Section O: Therapy Minutes, Days and Dates
  • Section O: Restorative Nursing
  • Respiratory Therapy MDS Audit Tool

3 CMS quality measure programs

Toolbox Content

cMS Quality measures

  • CMS QM Home Page
  • 5-Star Quality Rating System Technical Users Guide  
  • MDS 3.0 Quality Measures User’s Manual
  • Appendix A of QM User’s Manual – Lists Measures Detail
  • List of All Short Stay Measures vs Long Stay Measures
  • CMS SNF Nursing Home Compare Database
  • CMS SNF Nursing Home Provider Database

Nursing home compare

  • Nursing Home Compare
  • What is Nursing Home Compare and How Can It Help You?
  • *Nursing Home Compare – Find Your SNF’s STAR Rating
  • CMS SNF Nursing Home Compare Database
  • CMS SNF Nursing Home Provider Database
  • Learn How Ratings are Calculated
  • View Long Term Care (LTC) Facility Staffing Payroll-Based Journal (PBJ) data

quality reporting Program (SNF QRP)

  • CMS SNF QRP Home Page
  • CMS Video Summary of SNF QRP
  • SNF QRP FAQ CMS Document 
  • Skilled Nursing Facility Quality Reporting Program – Provider Data | Provider Data Catalog
  • SNF Quality Reporting Program Spotlights & Announcements
  • SNF Quality Reporting Program Training
    • Brief Interview for Mental Status (BIMS) Video Tutorial
    • Section GG Coding Training 
  • SNF Quality Reporting Program Public Reporting DATA
  • SNF Quality Reporting Program Measures and Technical Information
    • Measures
    • SNF QRP Measure Calculation and Reporting User’s Manual 
    • SNF QRP – Old Manuals
  • SNF QRP Table with MDS Questions Triggering 2% Penalty
  • SNF QRP Data Submission Deadlines

sNF value based purchasing (SNF VBP)

  • CMS SNF VBP Program Overview and Home Page 
  • SNF VBP Facility-Level Dataset | Provider Data
  • SNF VBP Program Performance Score Report User Guide
  • SNF VBP Score Overview – CMS YouTube Video
  • CMS – Accessing SNF VBP Confidential Reports – Instructions/Tutorial
  • Understanding the SNF VBP Report – Tutorial
  • SNF VBP – Understanding Confidential Feedback Report
  • MLN article (PDF) about the Program
  • Public Reporting
    • SNF VBP Program data are publicly available 

Coding, billing & documentation

Toolbox Content

Clinical Resources


  • Documentation: 
    • Fact Sheet: Requirements for Med A vs Med B
    • Evaluation Templates (Medicare Compliant)  
      • PT  |  OT  |  Communication |  Swallowing
    • Progress Report Templates  
      • PT  |  OT  |  Communication |  Swallowing
    • Daily Treatment Encounter Note Templates  
      • PT  |  OT  |  Communication |  Swallowing
      • Home Evaluation Forms   
  • Objective Tests and Measures
    • Tinetti Test
    • Berg Balance Test
    • Functional Reach Test
    • Single Leg Stance Documentation Flow Sheet 
    • Tandem Stance Documentation Flow Sheet 
    • 4 Square Step Test Documentation Flow Sheet
  • Maintenance Therapy Rules
    • Jimmo Fact Sheet 
    • Jimmo Updates 
  • ICD-10-CM Code List: LTC Therapy Most Common Codes
  • CPT Codes for PT, OT, SLP  
  • New CPT Therapy Evaluation Codes 
    • PT and OT Decision Chart for CPT Evaluation Codes by Complexity
    • PT Decision Chart and Documentation Tool – Eval Codes by Complexity
    • OT Decision Chart and Documentation Tool- Eval Codes by Complexity
  • What is Skilled Therapy Fact Sheet


  • Restorative Nursing Information – Section O of RAI Manual – Instructions
    • Documentation Template – Montero Custom
  • Respiratory Therapy MDS Audit Tool
  • What is Skilled Nursing: Fact Sheet  
  • Nurse Aide Worksheet: Template  
  • Montero Sample PPS  / Rehab Meeting – Data Collection Tool
  • Montero Sample Medicare Part A Triple Check Form
  • Montero Sample Therapy 3 Day Advanced Discharge Communication Form (to Nursing)
  • MONTERO BNI Info-Guide / Cheat Sheet
  • BNI Audit Form State Surveyors Use
  • ABN Training Document From CMS
  • Download and Customize:
    • NOMNC Form (Medicare Part A & B) – CMS 10123
    • DENC Form (Medicare Part A & B) – CMS 10124
    • SNF ABN Form (Medicare Part A)-CMS 10055
    • ABN CMS-R-131 (Medicare Part B)

ICD-10 Coding

Coding Manuals & resources

  • CMS Home Page for ICD-10-CM Information
  • CMS Guidelines for Coding 
  • ICD-10-CM Tabular List of Disease and Injury from
  • ICD-10-CM Index List of Disease and Injury from
  • ICD-10 Code Look-up Tool from
  • For SNF CPT Codes – See Medicare Part B Toolbox for Cheat Sheet

compliance resources

Toolbox Content

State Survey Resources


  • State Survey RESIDENT OBSERVATION Care Areas and Probes
  • State Survey RESIDENT INTERVIEW Care Areas and Probes
  • State Survey FAMILY INTERVIEW Care Areas and Probes
  • State Survey RECORD REVIEW Care Areas and Probes
  • State Survey Procedure Guide
  • State Survey LTCSP Mapping Document
  • State Survey List-of-Revised-FTags


  • State Survey Entrance Conference Form
  • Survey Preparation Tool for Therapy Staff 
  • State Survey – CMS Form 672 – Retired 10/1/23
  • State Survey – CMS Form 802 – Data Collection and Instructions
  • Survey Resources
  • Revision History for LTC Survey Process Documents and Files
  • State Operations Manual – Main Page
  • Link to CMS State Operations Manual – Appendix PP


  • SNF Beneficiary Protection Notifications NOMNC ABN
  • Dining Observation
  • Infection Prevention, Control & Immunizations
  • Kitchen Observation
  • Medication Administration Observation
  • Resident Council Interview
  • Quality Assessment and Assurance (QAA) and Quality Assurance and Performance Improvement
  • Abuse
  • Environmental Observations
  • Sufficient and Competent Nurse Staffing Review
  • Personal Funds Review
  • Activities
  • Activities of Daily Living (ADL)
  • Behavioral and Emotional Status
  • Urinary Catheter or Urinary Tract Infection 
  • Communication and Sensory Problems (Includes Hearing and Vision)
  • Dental Status and Services 
  • Dialysis 
  • General Care
  • Hospice and End of Life Care and Services 
  • Death 
  • Nutrition
  • Pain Recognition and Management
  • Physical Restraints
  • Pressure Ulcer/Injury
  • Specialized Rehabilitative or Restorative Services
  • Respiratory Care
  • Unnecessary Medications, Psychotropic Medications, and Medication Regimen Review 
  • Medication Storage and Labeling
  • Preadmission Screening and Resident Review 
  • Extended Survey
  • Hydration 
  • Tube Feeding Status
  • Positioning, Mobility & Range of Motion
  • Hospitalization
  • Bladder or Bowel Incontinence
  • Accidents
  • Neglect
  • Resident Assessment MDS
  • Discharge Planning
  • Dementia Care

Management & Compliance

therapy department management

  • Therapy Schedule and Minutes Tracker  
  • Billing and Tracking Forms:  PT |  OT |  SLP
  • Statistics and Report Forms 
  • Triple Check Meeting Forms Part A   Part B
  • Template Rehab Policy Manual (For Facility Members)

Therapy & Nursing compliance resources

  • State Operations Manual 
    • Major Manual Update – New F-Tag Labels (Index)
  • State Operations Manual
  • Fact Sheet: Documentation Requirements for Med A vs Med B  
  • What is Skilled Therapy: Fact Sheet  
  • CMS Targeted Probe and Educate (TPE) Audits