Medical Review Denials

January – March, 2020, Hospice Medical Review Top Denial Reason Codes
We encourage all providers to review this information when filing claims to prevent denials and to ensure their claims are processed timely. The following information affects providers billing 81X bill types.

81X bill type denials: Total denials 836

 

RankDenial CodeDenial Description# Claims% Claims Denied

1

56900

Auto Denial — Requested Records not Submitted

385

46.1

2

5CF36

Not Hospice Appropriate

124

14.8

3

5CNER

The Notice of Election Is Invalid Because It Doesn't Meet Statutory/Regulatory Requirements

54

6.5

4

5CFH9

Physician Narrative Statement Not Present or Not Valid

50

6.0

5

5CFH4

Initial Certification Not Signed

47

5.6


January — March, 2020, Home Health Medical Review Top Denial Reason Codes
We encourage all providers to review this information when filing claims to prevent denials and to ensure their claims are processed timely. The following information affects providers billing the 32X bill type.

There were a total of 1,966 claims denied for 32X bill type

 

 

Rank
Denial Code
Denial Description
# Claims
% Claims Denied
1
Auto Denial — Requested Records Not Submitted
971
49.4
2
Face-to-Face Encounter Requirements Not Met
260
13.2
3
Unable to Determine Medical Necessity of HIPPS Code Billed as Appropriate Oasis Not Submitted
218
11.1
4
No Plan of Care or Certification
120
6.1
5
Information Provided Does Not Support the Medical Necessity for This Service
24
1.2

 

Latest Articles

      

5CFTF - Face-to-Face Encounter Requirements Not Met 04/30/2020
5F041 and 5A041 - Information Provided Does Not Support Medical Necessity for this Service 04/28/2020
5FF2F and 5TF2F - Face-to-Face Encounter Requirements Not Met 04/28/2020
5FT10 and 5AT10 - Documentation Does Not Support Homebound Status 04/28/2020
5A301 - Information Provided Does Not Support the Medical Necessity for Therapy Services 08/07/2019
5F072 - No Physician's Order for Services or More Than Ordered 08/07/2019
5CFIP - Invalid Plan of Care Submitted 05/15/2019
5CF01 - General Inpatient Services Not Reasonable and Necessary 05/14/2019
5CF36 - Not Hospice Appropriate 05/14/2019
5CF91 - Hospice GIP Reduction - Services Not Reasonable/Necessary 05/14/2019
5CFH4 - Initial Certification Not Signed 05/14/2019
5CFH6 - Initial Certification Not Timely 05/14/2019
5CFH9 - Physician Narrative Statement Not Present or Not Valid 05/14/2019
5CFNP - No Plan of Care Submitted 05/14/2019
5CNER - The Notice of Election Statement Is Invalid Because It Doesn't Meet Statutory/Regulatory Requirements 05/14/2019
5FFH9 - Physician Narrative Statement Not Present or Not Valid 05/14/2019
5CNOE - No Valid Election Statement Submitted 05/04/2019
56900 - Auto Deny - Requested Records Not Submitted 02/26/2019
5A041 - Information Provided Does Not Support the Medical Necessity for This Service 02/26/2019
5CHG3 - MR HIPPS Code Change Due to Partial Denial of Therapy 02/26/2019
5F023 - No Plan of Care or Certification 02/26/2019
5F041 - Information Provided Does Not Support the Medical Necessity for This Service 02/26/2019
5FF2F - Face-to-Face Encounter Requirements Not Met 02/26/2019
5FNOA - Unable to Determine Medical Necessity of HIPPS Code Billed as Appropriate OASIS Not Submitted 02/26/2019
5T070 - Visits/Supplies/DME Billed Not Documented/Not Documented As Used 02/26/2019
   

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