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 |
|---|---|---|
Diet stated, intake not assessed | Therapeutic diet named with no intake or adherence evaluation. | Estimate intake and evaluate adherence to the prescribed diet. (See Denial Patterns 6.1.) |
Cloned nutrition narratives | Identical nutrition language copied visit to visit. | Re-document the visit's actual intake, weight, and any change. (6.2.) |
Weight change not interpreted | A weight loss charted with no risk threshold or action. | Interpret the percentage and timeframe against malnutrition thresholds. (6.3.) |
Diet taught without response | Therapeutic-diet teaching with no teach-back. | Document topic, method, audience, and mastery percentage. (6.4.) |
Notification without outcome | “MD notified” of intake or weight with no orders or response. | Close the loop: time, content, response/orders, follow-through. (6.5.) |
Enteral care without parameters | Tube feeding charted with no rate, tolerance, or site. | Document formula, rate, residual or tolerance, and the site. (6.6.) |
Skilled need not tied to dx/risk | Generic nutrition claim. | Connect the assessment to the diagnosis and the specific risk. (6.7.) |
Unsupported homebound | “Remains homebound” with no nutrition-related evidence. | Cite weakness, enteral dependence, or a preparation barrier and the taxing effort. (6.8.) |
Findings inconsistent with POC | Intake or diet conflicts with orders or the plan. | Align findings and teaching to the ordered diet and POC. (6.9.) |
Diagnosis present, diet not managed | A diet-sensitive diagnosis with no therapeutic-diet documentation. | Apply the matching disease overlay's diet parameters. (6.10.) |