The domain’s common reasons a Part A skilled day is down-coded or denied on medical review (ADR), and the corrected pattern. The full catalog lives in Denial Patterns.
Risk
Why it fails
Corrected pattern
No systemic surveillance
‘Stable’ without constitutional detail reads as non-skilled.
Document the constitutional signs and the early-sepsis screen. (ADR.)
Management/evaluation not shown
A complex plan without evidence of RN integration.
Document the reconciliation, correlation, and oversight of the unskilled care.
Decline not worked up
Generalized decline without a reversible-cause review.
Document the decline, the workup, and the plan/goals revision.
Fever not surveilled for sepsis
A fever treated without a source/sepsis screen.
Document the source assessment and sepsis surveillance.
