Hospice Medical Review Top Denial Reason Codes: January to March 2024

Published 07/31/2024

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.

81X Bill Type Denials: Total Denials 529

Rank Denial
Code
Denial Description # Claims % Claims Denied
1 56900 Auto Denial — Requested Records not Submitted 164 31.0
2 5CF36 Not Hospice Appropriate 159 30.1
3 5CNER The Notice of Election Is Invalid Because it Doesn't Meet Statutory/Regulatory Requirements 55 10.4
4 5CF92 Hospice Continuous Care Hours Reduction 24 4.5
5 5CF91 Hospice GIP Reduction — Services Not Reasonable/Necessary 23 4.3
6 5CFNP No Plan of Care Submitted 18 3.4
7 5CFH9 Physician Narrative Statement Not Present or Not Valid 15 2.8
8 5CFH3 No Certification for Dates Billed 14 2.6
9 5CFH6 Initial Certification Not Timely 9 1.7
5CFTF Face-to-Face Encounter Requirements Not Met 9 1.7

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