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 baseline comparison
‘Confused’ without the baseline reads as non-skilled and misses delirium.
Document cognition against the baseline and the delirium screen. (ADR.)
Delirium not recognized
An acute change not screened or acted on.
Screen for delirium (CAM) and the treatable trigger; escalate.
Section C unsupported
BIMS/CAM coded without the note to support it.
Carry the cognitive and delirium data in the note. (F641.)
Reflexive medication
Agitation medicated without a medical screen.
Screen for infection/pain/hypoxia/glucose first (route to Behavioral).
