Appeal Rationale Builder

Case Builder

Structured Inputs

1/2 Type A/D Determination G/M/P/S SNF Progress Q/N/U/T/E/I/F/V + badge Grouped Buttons C/R/X Actions Esc Exit field

Appeal Type

Switch between SNF and hospital discharge appeals.

Quick Start

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

Determination

Choose whether you agree or disagree with termination of coverage.

Case Facts

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

SNF Current Clinical State

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

Hospital Acute-Care Findings

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

Agree Findings

Disagree Findings

Documented Skilled Needs

Select only issues actually supported by the SNF record.

Wound Status IV Therapy Other Daily Monitoring

SNF Discharge Plan

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

Discharge Plan Detail

SNF Agree Reasons

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

Conclusion Phrase

SNF Disagree Reasons

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

Additional Clinical Fact

Optional single functional or therapy fact not captured above.

Additional Functional / Therapy Fact

Edge-Case Clause

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

Custom Clause