How Pennsylvania’s New 2025 Documentation Rules Put SNFs at Risk — and What Choice of System Ensures Compliance, Protects Revenue, and Improves Patient Care

Introduction: A New Era of Documentation for Pennsylvania SNFs

Pennsylvania’s skilled nursing facilities (SNFs) are facing some of the most sweeping documentation changes in years. Between the state’s transition to the Patient-Driven Payment Model (PDPM), tougher quality incentive programs, and new staffing and restraint regulations, the burden on providers to capture, code, and report accurately has never been greater.

For administrators, directors of nursing, and compliance officers, this moment brings both opportunity and risk. Done right, strong documentation improves compliance, reduces penalties, and increases reimbursement. Done poorly, it exposes facilities to fines, lost revenue, and reputational harm.

This is exactly where VerifyMedCodes.ai comes in — providing an AI-powered compliance and revenue cycle solution that ensures facilities don’t just “keep up” with documentation rules but actually profit from them while delivering better patient experiences.

1. The PDPM Transition: More Clinical Detail, Higher Stakes

On May 14, 2025, Pennsylvania DHS began shifting Medicaid reimbursements from the old RUG III system to PDPM. While RUGs relied heavily on therapy minutes, PDPM emphasizes clinical characteristics like patient comorbidities, functional status, and care needs.

This transition means:

• SNFs must capture far greater clinical detail in progress notes.

• Incomplete or vague documentation risks undercoding, leaving revenue on the table.

• Overdocumentation or errors risk compliance violations and audits.

VerifyMedCodes.ai helps solve this very issue:
The platform extracts complete clinical data from provider notes, automatically aligning them with PDPM categories. Facilities gain real-time alerts when documentation is incomplete, missing comorbidities, or failing to capture details that impact reimbursement. The result? Maximum payment accuracy without compliance risk.

2. Quality Incentive Programs (QIP & VBP): Pay for Performance Requires Proof

Pennsylvania’s Nursing Facility Quality Incentive Program (QIP) and updated Value-Based Purchasing (VBP) programs now directly tie reimbursement to performance benchmarks. Facilities must not only perform well but also prove it through documentation — including quality metrics, attestation forms, and webinar participation.

The challenge: Most SNFs still rely on staff manually logging this data across multiple systems, leaving gaps, errors, or late submissions.

How VerifyMedCodes.ai helps solve this issue as well:
The system centralizes and validates QIP/VBP documentation, ensuring all required metrics are captured, coded, and submitted on time. That means higher incentive payouts, fewer denials, and less staff time spent chasing paperwork.

3. Restraint Documentation: New Rules, No Room for Error

As of July 2024, Pennsylvania requires detailed documentation every time a restraint is used, including:

• Justification for the intervention

• Proof that the least restrictive option was used

• Identification of the staff member involved

• Shift-by-shift documentation until the restraint is removed

The risk: Missing just one required element could lead to survey deficiencies, citations, or worse.

How VerifyMedCodes.ai helps solve this as well:
Their structured documentation modules guide staff through compliant restraint reporting in real time, flagging missing details before submission. Facilities stay compliant, protect patient rights, and avoid costly penalties.

4. Staffing Minimums and Federal CMS Requirements

Pennsylvania’s enhanced staffing ratios (1 nurse aide per 12 residents during the day; 1 per 20 overnight) and CMS’s federal minimums (3.48 hours per resident day, with required RN presence) create another major reporting burden.

Facilities must now:

• Track and document staffing by shift, staff type, and hours worked

• Maintain proof of RN coverage 24/7

• Report compliance through facility assessments and audits

How VerifyMedCodes.ai helps:
The system integrates staffing documentation with compliance reporting, producing clean audit-ready records without staff needing to duplicate effort. Our system also cross-checks staffing against census data to highlight potential shortfalls before regulators do.

5. Regulatory Updates and Quarterly Reporting

Pennsylvania’s July 2023 regulatory overhaul requires facilities to maintain:

• Recent inspection reports

• Updated facility-wide assessments (quarterly)

• Accurate census, occupancy, and rate data

How VerifyMedCodes.ai helps this as well:
The system generates audit-ready reporting - as well as quarterly submissions, and it flags discrepancies in census and rates data automatically. This reduces administrative burden and ensures that when auditors arrive, facilities are ready.

6. Nurse Aide Registry Oversight

Pennsylvania now requires SNFs to cross-reference staff against the state’s Nurse Aide Registry, which records qualifications and flags misconduct. Documentation errors here can directly impact hiring and compliance audits.

VerifyMedCodes.ai solves this too:
The system integrates registry verification into the staffing documentation workflow, ensuring only qualified aides are logged. This closes compliance gaps and prevents costly hiring mistakes.

Why This Matters: The Financial and Patient Impact

When documentation breaks down, the consequences ripple across the entire system:

• Revenue Risk: Under PDPM, missing one comorbidity could cost thousands in lost reimbursement per patient.

• Compliance Risk: Incomplete restraint or staffing logs can trigger deficiencies, penalties, or lawsuits.

• Staff Burnout: Manual reporting eats up time that should be spent on direct resident care.

• Patient Experience: Poor documentation leads to fragmented care, delays, and lower satisfaction.

VerifyMedCodes.ai transforms this reality. By automating compliance, maximizing accurate reimbursement, and simplifying reporting, we allow SNFs, hospitals, rehab providers, and PT/OT practices to:

• Protect revenue and even increase margins by capturing every reimbursable detail

• Stay compliant with both state and federal regulations

• Free staff from paperwork to focus on residents

• Improve patient outcomes through complete, structured documentation

Bottom Line: Compliance Made Profitable

Pennsylvania’s documentation rules are only going to get tougher. Facilities that struggle with manual compliance risk falling behind financially and clinically. But those that leverage smart solutions like VerifyMedCodes.ai will thrive.

This particular system keeps you compliant, and it turns compliance into a financial advantage — boosting reimbursements, protecting margins, and delivering better care experiences for residents and patients alike.

In today’s world, compliance isn’t optional. But with VerifyMedCodes.ai, it doesn’t have to be painful. It can be profitable. This is one particular ai-assisted tools that is a very safe, and offers a brilliant, and one of the fastest use of AI in the country. It processes audit-ready notes in under two minutes, it offers guidance every step of the way, so it acts as an outstanding training tool, and the cost is per note; never more than $1.50 per note.

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