Home Health Top Medical Review Denial Reason Codes
July – September 2022
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.
Rank | Denial Code | Denial Description | # of Claims Denied | % of Claims Denied |
---|---|---|---|---|
1 | 5HN18 | Skilled nursing services were not medically necessary. | 528 | 30% |
Resources: |
||||
Rank | Denial Code | Denial Description | # of Claims Denied | % of Claims Denied |
2 | 5HC09 | The initial certification was missing/incomplete/invalid; therefore, the recertification episode is denied | 437 | 25% |
Resources:
|
||||
Rank | Denial Code | Denial Description | # of Claims Denied | % of Claims Denied |
3 | 5HC01 | The physician certification was invalid since the required face-to-face encounter was missing/incomplete/untimely. | 305 | 17% |
Resources:
|
||||
4 | 5HY01 | The medical documentation submitted did not show that the therapy services were reasonable and necessary and at a level of complexity which requires the skills of a therapist. | 223 | 13% |
Resources:
|
||||
Rank | Denial Code | Denial Description | # of Claims Denied | % of Claims Denied |
5 | 5HC04 | Physician or allowed practitioner's plan of care and/or certification present-no signature. | 56 | 3% |
Resources: |
Updated: 11.21.22