SNF Ancillary Charge Capture Audit

Inspection template for auditing ancillary charge capture in a skilled nursing facility, including beauty shop services, PPE-related charges, and documentation supporting compliant billing and safety controls.

Audit Scope and Source Documentation

• Audit period and sample population documented
  Audit record identifies the date range reviewed, number of resident accounts sampled, and the ancillary service categories included.
• Source documents available for each sampled charge
  Each sampled ancillary charge is supported by a source record such as service log, ticket, order, receipt, or resident statement.
• Charge date matches service date
  The posted charge date aligns with the date the ancillary service was provided or the date authorized by policy.
• Charge amount matches supporting documentation
  The billed amount matches the approved rate, receipt, or fee schedule for the service rendered.

Beauty Shop Service Charge Capture

• Beauty shop service log completed for each billed resident
  Service log includes resident name or identifier, service type, date, staff member, and charge amount.
• Resident authorization or consent on file where required
  Documentation shows the resident or authorized representative approved the beauty shop service and related charge, when required by facility policy.
• Beauty shop charges posted to the correct resident account
  Charges are assigned to the correct resident and not duplicated, omitted, or posted to the wrong account.
• Beauty shop pricing aligns with posted fee schedule
  The amount charged matches the facility's approved and posted beauty shop fee schedule.

Ancillary Supply and PPE Charge Controls

• Billable ancillary supplies are itemized and supported
  Itemized documentation exists for supplies charged to residents, including quantity, unit price, and service context.
• PPE-related charges are permitted by policy and law
  Any PPE-related charge is reviewed against facility policy and applicable employer payment requirements before billing to a resident.
• No duplicate or bundled charges identified
  The audit did not identify duplicate postings, double billing, or bundled charges that obscure the actual ancillary service billed.
• Charge adjustments and refunds documented
  Any reversals, credits, or refunds related to ancillary charges are documented with reason, date, and approving authority.

Operational Safety and Environment

• Beauty shop area free of blocked exits and ignition hazards
  Egress paths are unobstructed and the area is free from obvious fire hazards, including improper storage of flammables or heat-producing equipment.
• Electrical and equipment cords in safe condition
  Portable equipment, cords, and plugs used in ancillary service areas are intact, not frayed, and not creating a trip or shock hazard.
• Required PPE available and used appropriately
  Staff use the PPE required for the task, and PPE is available in the service area when needed for resident care or cleaning activities.
• Housekeeping and sanitation adequate in service area
  Work surfaces, tools, and storage areas are clean, organized, and maintained to reduce contamination and safety risks.

Reconciliation, Exceptions, and Sign-Off

• Missed ancillary charges quantified
  Any omitted charges identified during the audit are quantified by resident, date, service type, and dollar amount.
• Exceptions categorized by root cause
  Exceptions are categorized, such as missing documentation, incorrect rate, incorrect resident account, or unauthorized charge.
• Corrective action plan documented
  For any failed critical item or material exception, document the corrective action, owner, and target completion date.
• Inspector sign-off completed
  Inspector confirms the audit findings and completion of required follow-up actions.