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
Rehab-nursing not documented
Recovery assumed, not shown with an RN evaluation.
Document the rehabilitation-nursing carryover and RN evaluation. (ADR; route to Restorative.)
Secondary prevention not managed
No BP goal/antithrombotic surveillance.
Document the secondary-prevention parameters and surveillance.
Complication surveillance thin
No aspiration/DVT/mood/recurrent-stroke screen.
Document the complication surveillance each shift.
MDS deficit set unsupported
Section GG/C/B coded without the note.
Carry the deficit and function data in the note. (F641.)
