Map which Chapter 8 bases apply, then show the need is daily and can be met only in a SNF (the practical-matter test). This is what a coverage reviewer looks for on a Part A day.
Observation & assessment of an unstable condition
Systemic/constitutional change — especially fever and early sepsis — carries a reasonable potential for a serious acute illness; detecting it requires nursing judgment daily.
Management & evaluation of the care plan
Where a complex resident’s interacting problems require an RN to integrate the plan and keep the unskilled care achieving its purpose, management and evaluation is itself the skilled service.
