17. Common audit and denial risks
System-specific patterns that draw denials and additional documentation requests, with the corrected pattern and the Segment 6 cross-reference. The full catalog lives in Denial Patterns.
Risk | Why it fails | Corrected pattern |
|---|---|---|
“Neuro intact”, no exam | A conclusion with no examination components or stroke screen. | Document the examination components and the stroke screen. (See Denial Patterns 6.1.) |
Cloned neuro narratives | Identical neurologic language copied visit to visit. | Re-document the visit's actual examination and any change. (6.2.) |
Deficit without grade/onset | Weakness charted with no grade, symmetry, or onset. | Grade strength by group with symmetry and onset. (6.3.) |
Stroke teaching without response | Stroke-sign teaching with no teach-back. | Document topic, method, audience, and mastery percentage. (6.4.) |
Notification without outcome | “MD notified” of a deficit with no orders or response. | Close the loop: time, content, response/orders, follow-through. (6.5.) |
Acute deficit not escalated | A focal deficit charted without emergency activation. | Activate emergency response for a positive stroke screen and document it. (6.6.) |
Skilled need not tied to dx/risk | Generic neuro-monitoring claim. | Connect the assessment to the diagnosis and the specific risk. (6.7.) |
Unsupported homebound | “Remains homebound” with no neurologic evidence. | Cite the deficit and the assistance need and the taxing effort. (6.8.) |
Findings inconsistent with POC | Neurologic findings conflict with orders or the plan. | Align findings and the plan. (6.9.) |
Baseline change not addressed | A change from the neurologic baseline never acted on. | Document and act on the change from baseline. (6.10.) |