Assignment Task:
I need an appeal letter countering and stating medical based facts why the denial is inaccurate, and they need to approve care for this patient immediately.
These reasons the patient was denied inpatient rehab are not true.
This member/patient has been referred by a doctor at the acute hospital to inpatient rehab due to a diagnosis of Metabolic Encephalopathy from hypercapnia, acute hypoxic respiratory failure secondary to pulmonary edema. This patient with past medical history of Obstructive Sleep Apnea, Heart Failure with reduced injection fraction, asthma, tobacco use, and hypertension presented to SFCH ED on 3/23 with complaints of chest pain and shortness of breath. Per records, patient has been out of his Lasix and oxygen for several months because he did not follow up with his PCP. (which shows the need for the education he old receive at acute inpatient rehab) On arrival to emergency department member, was noted with oxygen saturation in the 80's on room air and was lethargic. Initial ABG showed pH 7.26 and pCO2 67. CXR with pulmonary edema. Patient had a BNP 151, Trop 62, EKG without ischemic changes, and WBC 8.5. Given 80 mg IV Lasix and DuoNeb. ECHO showed EF 45-50% with Grade 1 diastolic dysfunction. Viral panel was negative. After several hours on BiPAP with IPAP 18 his pCO2 worsened to 73 and pH still 7.26. ICU called for admission. POCUS exam showed, dilated Right Ventricle and dilated IVC without respiratory collapse indicative of volume overload. Pt underwent diuresis with intravenous Lasix, stepped down to the medical floor on 3/27, currently on O2 at 6 lpm maintaining oxygen saturation around 93%, hemodynamics are stable. Treatment to date Continue BiPAP protocol at Hs, Titrate IPAP to maintain MV > 8 L/min and pH 7.35 to 7.45 Titrate FiO2 to maintain oxygen saturation > 92% Follow CXR. ABG/VBG as needed. Prior to onset, member was independent with mobility and ADLs. His current level of function has been greatly impacted by current illness. Member shows to be the perefct candidate for inpatient rehab because he is progressing well in bed mobility and transfers. He is now being referred to IRF level of care to address functional deficits. Intensive rehab program is required to maximize pts recovery due to potential risk factors in combination with current functional status. Need Assignment Help?
They are denying patient stating the following
1. Patient does not need to be seen by a rehab doctor at least three times a week for evaluation of functional and medical goals and progress, 2. You do not need at least two therapies a day (occupational, physical or speech).3. You do not need and are not able to take part in three hours of therapy a day at least 5 days a week or 15 hours per week. 4.You do not need to see a rehab doctor 3 days a week.
However. All these are not true, and inpatient rehab is broken down and modified for a therapeutic approach throughout the day to complete the 3 hours. I need it to show why Patients other medical comorbidities show he must at the least see a doctor 3 days a week, that is the only safest option with his history. If he is sent to a lower level of care he is at a huge risk of rehospitalization or injury. This patient will face many challenges if he does not get inpatient rehab level of care as he was living independently prior to this hospitalization.