5H161: No Physician's Orders

This claim was fully or partially denied because there were no physician’s orders submitted for review for all or some of the services billed.

To Prevent This Denial

• A physician’s order should be submitted for review with the request for copies of medical records
• A legible signature is required on all documentation necessary to support orders and medical necessity
• The copy of the order should be legible and dated
• Make sure any orders submitted for review are for the dates of service billed

Resources

• Code of Federal Regulations, 42 CFR – Section 410.32
• CMS Internet-Only Manuals (IOMs), Medicare Program Integrity Manual, Publication 100-08, Chapter 3, Section 3.3.2.4 (PDF)