Home Health Top Medical Review Denial Reason Codes
April – June 2020
The following information provides home health medical review denial data related to the most recent calendar quarter. Please review this information and the educational resources to assist with preventing these types of denials. Refer to the Home Health Denial Reason Codes Web page for a complete list of denial codes.
Note: On March 13, 2020, Secretary Azar authorized waiver and modifications under §1135 of the Social Security Act retroactive to March 1, 2020. Therefore, Medical Review Targeted Probe and Educate (TPE) reviews were temporarily suspended. As a result, the suspension influenced the following denial statistics.
Rank | Denial Code | Denial Description | # of Claims Denied | % of Claims Denied |
---|---|---|---|---|
1 |
5HC01 |
The physician certification was invalid since the required face-to-face encounter was missing/incomplete/untimely. |
5 |
29% |
Resources:
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Rank | Denial Code | Denial Description | # of Claims Denied | % of Claims Denied |
2 |
5HO01 |
Medicare requires that all services be ordered by a physician. The denied visits were not ordered or exceeded the physician's orders. |
2 |
12% |
Resources:
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Rank | Denial Code | Denial Description | # of Claims Denied | % of Claims Denied |
3 |
5HO02 |
The order(s) are incomplete as they must indicate discipline, frequency duration, and treatment. |
2 |
12% |
Resources: |
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Rank | Denial Code | Denial Description | # of Claims Denied | % of Claims Denied |
4 |
56900 |
Requested documentation not received/received untimely |
2 |
12% |
Resources:
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Rank | Denial Code | Denial Description | # of Claims Denied | % of Claims Denied |
5 |
5HN18 |
Skilled nursing services were not medically necessary. |
1 |
6% |
Resources: |
Posted: 08.26.20