Evaluates hospital admission packets to determine if inpatient or observation status is clinically supported. Uses a two-step workflow with clinical review checkpoint. Analyzes ADT, ORU (labs/vitals), and MDM clinical notes against Medicare two-midnight rule and severity criteria. Use when reviewing admission status decisions, inpatient vs observation classification, utilization review, or two-midnight compliance audits.
Screens inpatient/observation status decisions after the hospital has coded the patient but before claim submission—catching likely denials based on ICD-10 validation, documentation gaps, medical necessity alignment, and Two-Midnight Rule compliance.
Target Users: Hospital case managers, utilization review nurses, admitting physicians
This skill uses a 2-step workflow with a clinical review checkpoint:
Step 1: Intake & Assessment
↓ (parse data, apply rubric, generate preliminary verdict)
↓ writes: waypoints/assessment.json
[User Checkpoint: Review & Confirm]
Step 2: Decision & Letter
↓ (capture reviewer input, generate report)
↓ writes: waypoints/decision.json
↓ writes: outputs/status-validation-report.md
Before starting, check if waypoints/assessment.json exists:
IF waypoints/assessment.json exists AND status = "assessment_complete":
→ Ask: "Found existing assessment for [MRN]. Resume from Step 2? (Y/N)"
→ If Y: Skip to Step 2
→ If N: Start fresh from Step 1
ELSE:
→ Start from Step 1
Execute: Read and follow references/01-intake-assessment.md
Input: 4 data files (ADT, ORU labs, ORU vitals, MDM note)
Process:
Output: waypoints/assessment.json
After Step 1: Display summary and ask: "Ready to proceed to Step 2: Clinical Review & Letter Generation? (Y/N)"
Execute: Read and follow references/02-decision-letter.md
Input: waypoints/assessment.json
Process:
assets/letter-template.mdOutput:
waypoints/decision.jsonoutputs/status-validation-report.md| Verdict | Meaning | Denial Risk | Action |
|---|---|---|---|
| SUPPORTED | Evidence justifies status decision | LOW | Proceed to submission |
| AT RISK | Borderline — documentation gaps exist | MEDIUM | Strengthen documentation |
| LIKELY DENIAL | Evidence does not support status | HIGH | Change status or escalate |
| File | Purpose |
|---|---|
| rubric.md | Clinical criteria thresholds for labs, vitals, MDM |
| tools.md | MCP tool integration patterns (ICD-10, CMS Coverage) |
| references/01-intake-assessment.md | Step 1 detailed workflow |
| references/02-decision-letter.md | Step 2 detailed workflow |
| assets/letter-template.md | Report template with placeholders |
This skill integrates with:
ICD10_Codes - Diagnosis code validation, hierarchy, specificity checksCMS_Coverage - Medicare coverage policy lookup (optional)daisy-skill-1/
├── SKILL.md ← You are here (orchestrator)
├── rubric.md ← Clinical criteria thresholds
├── tools.md ← MCP tool integration
├── references/
│ ├── 01-intake-assessment.md ← Step 1 logic
│ └── 02-decision-letter.md ← Step 2 logic
├── waypoints/
│ ├── assessment.json ← Step 1 output (resume state)
│ └── decision.json ← Step 2 output
├── outputs/
│ └── status-validation-report.md ← Final report
├── assets/
│ └── letter-template.md ← Report template
├── sample-data/
│ ├── adt-a01-admission.json
│ ├── oru-r01-labs.json
│ ├── oru-vitals.json
│ └── mdm-t02-ed-note.json
└── examples/
└── case-001-sepsis-cap.md ← Reference output
User: Run status determination on the sample data in sample-data/
Claude:
1. Loads sample-data/adt-a01-admission.json, oru-r01-labs.json,
oru-vitals.json, mdm-t02-ed-note.json
2. Executes Step 1 (01-intake-assessment.md)
3. Writes waypoints/assessment.json
4. Displays checkpoint summary
5. User confirms agreement
6. Executes Step 2 (02-decision-letter.md)
7. Writes outputs/status-validation-report.md
8. Displays completion with verdict and action items