Hospice Medical Review Top Denial Reason Codes: Q4 2024

Published 03/17/2025

Medical Review Top Denial Reason Codes for Hospice from October to December 2024

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.

Total 81X Bill Type Denials: 349

Table 1. 81X Bill Type Denials.
Rank Denial
Code
Denial Description # Claims % Claims Denied
1 5CF36 Not Hospice Appropriate 163 46.7
2 56900 Auto Denial — Requested Records not Submitted 47 13.5
3 5CNER The Notice of Election Is Invalid Because It Doesn't Meet Statutory/Regulatory Requirements 37 10.6
4 5CFTF Face-to-Face Encounter Requirements Not Met 15 4.3
5 5CFH3 No Certification for Dates Billed 11 3.2
6 (tie) 5CFH7 Subsequent Certification Not Timely 9 2.6
5CFH9 Physician Narrative Statement Not Present or Not Valid 9 2.6
8 (tie) 5CFNP No Plan of Care Submitted 8 2.3
5CFH6 Initial Certification Not Timely 8 2.3

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