Denials
October – December 2022 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 32X bill types.
32X Bill Type Denials: Total Denials 1,843
|
Rank |
Denial Code |
Denial Description |
# Claims |
% Claims Denied |
|
1 |
Auto Denial — Requested Records Not Submitted |
748 |
40.6 |
|
|
2 |
Face to Face Encounter Requirements Not Met |
621 |
33.7 |
|
|
3 |
No Plan of Care or Certification |
250 |
13.6 |
|
|
4 |
Information Provided Does Not Support the Medical Necessity for This Service |
43 |
2.3 |
|
|
5 |
Visits/Supplies/DME Billed Not Documented/Not Documented As Used |
34 |
1.8 |
|
|
6 |
No Physician's Orders for Services |
31 |
1.7 |
|
|
7 |
No Physician's Orders for Services |
21 |
1.1 |
|
|
7 |
Information Provided Does Not Support the Medical Necessity for This Service |
21 |
1.1 |
|
|
7 |
|
Visits/Supplies/DME Billed Not Documented/Not Documented As Used |
21 |
1.1 |
|
10 |
Documentation Does Not Support Homebound Status |
17 |
0.9 |
October – December 2022 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 853
|
Rank |
Denial |
Denial Description |
# Claims |
% Claims Denied |
|
1 |
The Notice of Election Is Invalid Because it doesn't Meet Statutory or Regulatory Requirements |
250 |
29.3 |
|
|
2 |
Auto Denial — Requested Records Not Submitted |
223 |
26.1 |
|
|
3 |
Not Hospice Appropriate |
178 |
20.9 |
|
|
4 |
Physician Narrative Statement Not Present or Not Valid |
37 |
4.3 |
|
|
5 |
Face to Face Encounter Requirements Not Met |
27 |
3.2 |
|
|
6 |
Hospice GIP Reduction — Services Not Reasonable/Necessary |
25 |
2.9 |
|
|
7 |
Initial Certification Not Timely |
16 |
1.9 |
|
|
7 |
No Valid Election Statement Submitted |
16 |
1.9 |
|
|
9 |
Subsequent Certification Not Timely |
15 |
1.8 |