Home Health RCD Top 5 Non-Affirmation and Claim Denial Reasons


We encourage all providers to review this information ensure claims and pre-claim review (PCR) requests are processed timely. The following chart shows the cumulative non-affirmation and claim denial reasons for all RCD states.

Rank

Code

Category

Description

1

HH01D

Face-to-Face

The physician certification was invalid since the required face-to-face encounter was not related to the primary reason for home health services. Refer to CMS IOM Publication 100-02, Chapter 7, Section 30.5.1.2 (PDF, 543 KB).

2

HH01A

Face-to-Face

The physician certification was invalid since the required face-to-face encounter document (actual clinical note for the face-to face encounter visit for admissions on/or after 1/1/15, or the narrative for admissions on/or after 4/1/11 and before 01/01/15) was missing. Refer to CMS IOM Publication 100-02, Chapter 7, Section 30.5.1.1 and 30.5.1.2 (PDF, 543 KB).

3

HH01B

Face-to-Face

The physician certification was invalid since the required face-to-face encounter was untimely and/or the certifying physician did not document the date of the encounter. Refer to CMS IOM Publication 100-02, Chapter 7, Section 30.5.1 (PDF, 543 KB).

4

HH02B

Plan of Care/Certification/Recertification

The content of the plan of care submitted was insufficient. Refer to CMS IOM Publication 100-02, Chapter 7, Section 30.2.1 (PDF, 543 KB).

5

HH05B

Subsequent Episodes

There was no valid initial physician's certification of patient eligibility, therefore services on the subsequent episode may not be allowed. Refer to CMS IOM Publication 100-08, Chapter 6, Section 6.2.1 (PDF, 251 KB).





Last Updated: 06/03/2021