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 |
|---|---|---|
“Hydration adequate”, no data | A conclusion with no examined signs or measures. | Document the hydration signs, intake/output, and the balance. (See Denial Patterns 6.1.) |
Cloned hydration narratives | Identical fluid language copied visit to visit. | Re-document the visit's actual signs, intake/output, and change. (6.2.) |
Deficit/overload not distinguished | Fluid status charted without differentiating the two. | State the signs that distinguish deficit from overload. (6.3.) |
Fluid plan taught, no response | Restriction or encouragement teaching with no teach-back. | Document topic, method, audience, and mastery percentage. (6.4.) |
Notification without outcome | “MD notified” of a finding with no orders or response. | Close the loop: time, content, response/orders, follow-through. (6.5.) |
I&O without interpretation | Intake and output charted with no balance or action. | Interpret the balance against the ordered plan and the trend. (6.6.) |
Skilled need not tied to dx/risk | Generic hydration claim. | Connect the assessment to the diagnosis and the specific risk. (6.7.) |
Unsupported homebound | “Remains homebound” with no fluid-related evidence. | Cite dizziness, weakness, or an access limitation and the taxing effort. (6.8.) |
Findings inconsistent with POC | Fluid status conflicts with orders or the plan. | Align findings and teaching to the ordered fluid plan. (6.9.) |
Diagnosis present, fluid not managed | A fluid-sensitive diagnosis with no fluid-plan documentation. | Apply the matching disease overlay's fluid parameters. (6.10.) |