July to September 2023 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.
|
Rank |
Denial Code |
Denial Description |
# Claims |
% Claims Denied |
|---|---|---|---|---|
|
1 |
Auto Denial — Requested Records not Submitted |
1,103 |
41.7 |
|
|
2 |
Face to Face Encounter Requirements Not Met |
733 |
27.7 |
|
|
3 |
No Plan of Care or Certification |
334 |
12.6 |
|
|
4 |
Information Provided Does Not Support the Medical Necessity for This Service |
79 |
3.0 |
|
|
5 |
Unable to Determine Medical Necessity of HIPPS Code Billed as App Oasis Not Submitted |
67 |
2.5 |
|
|
6 |
Information Provided Does Not Support the Medical Necessity for Therapy Services |
59 |
2.2 |
|
|
7 |
Visits/Supplies/DME Billed Not Documented/Not Documented As Used |
55 |
2.1 |
|
|
8 |
Information Provided Does Not Support the Medical Necessity for Therapy Services |
42 |
1.6 |
|
|
9 |
Visits/Supplies/DME Billed Not Documented/Not Documented As Used |
37 |
1.4 |
|
|
10 |
No Physician's Orders for Services |
35 |
1.3 |