Appeal Rationale Builder

Case Builder

Structured Inputs

1/2 Type A Agree D Disagree G/M/P/S SNF Progress C Copy R Copy & Reset Esc Exit field

Switch between SNF and hospital discharge appeals.

Presets change with the appeal type. Use them as a starting point, not as the final review.

Choose whether you agree or disagree with termination of coverage.

These facts drive the opening lines of the rationale.

Age Gender SNF Admission Date Review Through Date

Hospitalization / Case Reason Hospital Course Summary Include “I have reviewed this beneficiary's chart...” opener

The patient's current function and therapy status should be represented in SNF rationales.

Bed Mobility Transfers Ambulation Assistance Device Ambulation Distance

feet

Wheelchair Mobility Assistance Wheelchair Mobility Distance

feet

Unable to Ambulate

Weight-Bearing Status Pain Status Precautions ADL / Self-Care Assistance

Select the acute-care findings that support the current hospital determination.

Agree Findings

Disagree Findings

Select only issues actually supported by the SNF record.

Wound Status IV Therapy Other Daily Monitoring

Record the documented plan without turning it into a directive about where the patient should go.

Discharge Plan Detail

These are the specific reasons daily inpatient skilled services are no longer needed.

Conclusion Phrase

These are the specific reasons daily inpatient skilled services still are needed.

Optional single functional or therapy fact not captured above.

Additional Functional / Therapy Fact

Optional single sentence for a case-specific fact not captured above.

Custom Clause