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
Gross-exam charting
‘Neuro intact’ without a focal exam reads as non-skilled.
Document the focal deficit exam vs the baseline and the reason observation was skilled. (ADR.)
No trajectory
No comparison of the deficit to the prior value.
Re-document the actual exam and the change since the last shift.
Rehab-nursing not documented
Stroke carryover assumed, not shown.
Document the rehabilitation-nursing delivery and RN evaluation. (Route to Restorative.)
MDS cognition/function unsupported
Section C/GG coded beyond the note.
Carry the cognitive and functional data in the note. (F641.)
