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
Deficit not tied to the plan
Communication status noted without the link to participation/safety.
Document how the deficit affects the skilled plan and the method/management applied. (ADR.)
No method/call-signal documented
A nonverbal resident with no established method.
Document the communication method and the reliable call-signal.
Change not escalated
A new deficit noted without a stroke screen.
Screen (BE-FAST) and escalate a new communication deficit.
Section B unsupported
B0700/B0800 coded without the note.
Carry the communication status and method in the note. (F641.)
