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 BP parameters/values
‘BP stable’ without values/parameters reads as non-skilled.
Document BP against the ordered parameters and the judgment applied. (ADR.)
Standalone-HTN overreach
Billing skilled solely for stable hypertension.
Document BP management as a contributing element of the primary skilled diagnosis.
Titration without response
Antihypertensive change without a measured effect.
Document the BP response and tolerance.
Over-treatment missed
Hypotension/falls not linked to the medication.
Document over-treatment recognition and fall-risk management.
