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
Device under-documented
‘CPAP on’ without settings/tolerance/SpO₂.
Document the settings, mask fit, tolerance, adherence, and overnight SpO₂. (ADR.)
Reversal not screened
A sleep-wake change not screened for delirium.
Screen (CAM) and for a trigger, and escalate a reversal.
Sleep not tied to the plan
Poor sleep noted without the participation link.
Document how sleep affects the skilled plan and the intervention.
