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
‘On antibiotics’ without the systemic picture/trend.
Document the systemic surveillance and the sepsis trend each shift. (ADR.)
Sepsis not recognized early
New confusion/fever not screened for sepsis.
Screen for sepsis (including new confusion) and initiate the pathway.
IV antibiotic under-documented
IV antibiotic coded without administration/response.
Document the IV antibiotic administration, line, and response. (F641.)
Recovery surveillance thin
Post-sepsis recovery with no recurrence watch.
Document the recovery trajectory and recurrence surveillance.
