In a previous article, we covered the basics of ethical and effective documentation practices to use in the long-term care setting. We learned that documentation can not only make the difference between saving or sacrificing you and your license, but also can make a positive impact on resident outcomes. With the basics in mind, we will explore the keys to successful skilled documentation. Why is that so important? Medicare reviewers do not ever physically see the resident; the key to their decision to pay the claim or not is in the medical record. Every entry in the medical record needs to build the case that the resident is being provided services and care that meet the definition of skilled services, that the services are so inherently complex they can only be provided by or under the supervision of professional or technical personnel. In addition, the nature of the service and the skills required for safe and effective delivery are the deciding factors.